Bovine tuberculosis symptoms. What is tuberculosis. Comments on “diaskintest vs mantoux”
is a chronic disease with localization of lesions in most internal organs. Both animals and humans are susceptible to it. Historical reference. Very old evidence supports the presence of tuberculous lesions in Egyptian mummies. Hippocrates describes hemoptysis, a pulmonary hemorrhage associated with consumption (tuberculosis), and suggests that it is contagious. Even before the discovery of the causative agent of tuberculosis, Willemin in 1865 indicated that the disease was contagious and revealed the ways of its transmission from animals to humans and from one animal to another.
Tuberculosis is one of the most dangerous infections on earth. The danger of this infection lies in the high percentage of deaths and disability, which in turn are the result of the high resistance of the tuberculosis pathogen to drugs, the presence of multiple drug resistance and the lack of effective preventive measures.
In the overall structure of mortality from all infectious diseases, tuberculosis is one of the leading causes. In Russia, about 68 people die of tuberculosis every day. In Moscow in 2012, 169 people were registered. who died of tuberculosis.
Due to high disability, high economic damage and mortality, tuberculosis is considered a socially significant infection.
Most often, tuberculosis affects the organs of the respiratory system (lungs, bronchi, pleura), but other organs can also be affected. In view of this, according to localization, pulmonary tuberculosis and extrapulmonary tuberculosis (intestines, bones, skin, etc.) are distinguished.
Pathogen, pathogen reservoir, routes of transmission and excretion. The disease is caused by the causative agent Mycobacterium tuberculosis. There are the following main types of pathogen, pathogenic for humans and animals. Modern scientific data have established that the causative agent of tuberculosis can infect animals not only of the species to which it has adapted, but also of many other species.
Thus, a pathogen of the human type, in addition to humans, can affect dogs, cats, pigs, monkeys, parrots, and, from laboratory animals, guinea pigs. The causative agent of bovine tuberculosis, in turn, in addition to cattle, can also infect humans, cats, pigs, goats, sheep, dogs and hares. The causative agent of avian tuberculosis infects pigs, horses, cats, and, as has been proven recently, quite often even humans.
Tuberculosis incidence
All sick animals (regardless of the type of pathogen) pose a danger to human health. IN 
in turn, a person with tuberculosis is a source of an infectious agent for animals, from which other, healthy people can become infected. Tomescu (1942) described many cases of human-type tuberculosis in monkeys from one of the menageries. All of the above indicates the need for a comprehensive fight against tuberculosis, both in humans and all animal species susceptible to tuberculosis.
Shortly after the discovery of the causative agent of tuberculosis by Robert Koch, it was found that the incidence of bovine tuberculosis is a danger to humans and especially to children. So, in 1933. Gervois (France) determined that out of 17,045 cases of tuberculosis described in the literature, 11.2% were caused by bovine pathogens. In Poland, the incidence of bovine tuberculosis in humans is, according to Mulak (1962), 17.5-19.2%. It is interesting to note that the proportion of cases of bovine tuberculosis is related to the age of the patients. The frequency of such cases, for example in children, fluctuates, according to various statistics, between 16 and 36%, reaching even 41%. As Wilson points out, in England, bovine tuberculosis most often affects children of preschool age. In general, the most dangerous age is considered to be from 2 to 4 years. According to Park and Krumvid, before the age of 5 years, the proportion of cases of bovine tuberculosis is 26.5%, at the age of 5-15 years - 25% and over the age of 15 years - 1.5%.
It has long been noticed that in rural areas the incidence of bovine tuberculosis is more common than in cities. Sigurdson (1945) found the causative agent of the bovine type in 3.6% of patients in large cities of Denmark, in 27.5% in other cities and in 40% in the villages of this country. For rural areas, Gertler also indicates the figure of 40%. As special studies have shown, the prevailing idea that bovine tuberculosis is rarely localized in the lungs should be reconsidered, Lindau found that in Sweden 60% of patients with tuberculosis caused by bovine mycobacteria had a pulmonary form, and Christiansen believes that the pulmonary form in rural areas is 60.8% in women and 76.9% in men. After examining 607 cultures of Koch's bacillus isolated from humans, Al. Pop (1969) found that 9.06% of them were bullish. As Meissner showed, in Germany, out of 4784 cultures studied, 10% belonged to the bovine type, including 5% in the pulmonary form, and 19% in other localization, especially in children.
The causative agent of tuberculosis
The causative agent of bovine tuberculosis causes the disease mainly among livestock workers living near animal holdings and in children who consume milk from TB-sick cows. Tuberculosis can also be contracted by workers in slaughterhouses. Most often, the causative agents of bovine tuberculosis enter the human body through the digestive tract, but the possibility of their entry through the respiratory tract (aerogenic infection) cannot be ruled out; In this second way, the attendants of livestock farms become infected by inhaling the causative agents of tuberculosis that are in the air of the barnyard. Milk is a food product that plays a significant role in the spread of pathogenic microbes. The content of the causative agent of tuberculosis in milk is proportional to the degree of the infected animal from which it was obtained. Mixing milk from several cows leads to infection of a large amount of milk.
In the same, if not more dangerous to human health, dairy products for the preparation of which unboiled milk is used. Some of them, such as cream and sour cream, contain more tuberculosis bacteria than milk, due to the phenomenon of flotation. In dairy products, the pathogen remains viable for a long time: in butter - 21 days, in peasant cheese 50-60 days, in Swiss and other slowly ripening cheeses 30-240 days. Since dairy products are not consumed locally, but enter the trade network, they become a factor in the spread of the pathogen over long distances. According to some authors, tuberculosis caused by a causative agent of a bovine type proceeds more severely and is more often accompanied by generalization than tuberculosis caused by a pathogen of a human type (Bungetseanu and Ionica, 1967).
The number of recovered patients is 2 times higher among patients with human type tuberculosis than among patients with bovine type tuberculosis. Of the 35 cases of pulmonary tuberculosis caused by the bovine pathogen, 15 cases also affected other organs. 9 times during treatment, a disease of the meninges was unexpectedly detected, 7 times - chronic tuberculosis of the kidneys, and, in addition, there was one case of tuberculosis of the knee joint, intestines and larynx. In a similar group of patients with human-type tuberculosis, lesions in the kidneys were found only in two cases. The mentioned authors claim that the number of lethal outcomes in the pulmonary form of bovine type tuberculosis was higher (almost 3 times), although both groups are similar in terms of the degree of development of the disease and all patients lived in rural areas.
Spread of tuberculosis occurs mainly among workers of livestock farms living near places where animals are kept, and in children who consume milk from cows with tuberculosis. Some types of tuberculosis can also be contracted by workers in slaughterhouses. Most often, the causative agents of bovine tuberculosis enter the human body through the digestive tract, but the possibility of the spread of tuberculosis through the respiratory tract (aerogenic infection) cannot be ruled out; In this second way, the attendants of livestock farms become infected by inhaling pathogens that are in the air of the barnyard.
Milk is a food product that plays a significant role in the spread of tuberculosis and other types of infections. The content of the pathogen in milk is proportional to the degree of infection of the animal from which it was obtained. Mixing milk from several cows leads to infection of a large amount of milk. In the same, if not more dangerous to human health, dairy products for the preparation of which unboiled milk is used.
Some of them, such as cream and sour cream, contain more tuberculosis bacteria than milk, due to the phenomenon of flotation. In dairy products, the pathogen remains viable for a long time: in butter - 21 days, in peasant cheese 50-60 days, in Swiss and other slowly ripening cheeses 30-240 days. Since dairy products are not consumed locally, but are sold in the trade network, they become a factor in the spread of tuberculosis over long distances.
According to some authors, tuberculosis caused by a causative agent of a bovine type proceeds more severely and is more often accompanied by generalization than tuberculosis caused by a pathogen of a human type (Bungetseanu and Ionica, 1967). The number of recovered patients is 2 times higher among patients with human type tuberculosis than among patients with bovine type tuberculosis. Of the 35 cases of pulmonary tuberculosis caused by the bovine pathogen, 15 cases also affected other organs. 9 times during treatment, a disease of the meninges was unexpectedly detected, 7 times - chronic tuberculosis of the kidneys, and, in addition, there was one case of tuberculosis of the knee joint, intestines and larynx.
In a similar group of patients with human-type tuberculosis, lesions in the kidneys were found only in two cases in one natural focus of the disease. The mentioned authors claim that in the case of pulmonary bovine tuberculosis, the number of deaths was higher (almost 3 times), although both groups were similar in terms of the degree of development of the disease and all patients lived in rural areas.
Forms of tuberculosis
Pigs can become infected with bovine, avian, and human-type tuberculosis. The incidence of pigs is associated with the spread of tuberculosis among cattle and poultry. The source of the infectious agent is sick animals kept near pigsties, as well as infected food waste used for feeding. This is the milk of sick cows or waste from its processing, food waste from tuberculosis hospitals and sanatoriums that have not undergone heat treatment. Thus, the main route of penetration of the pathogen into the body of a pig is the digestive tract.
The disease manifests itself in different ways, depending on the form of tuberculosis. In the pulmonary form of tuberculosis, the disease occurs against the background of a feverish state and is accompanied by cough, respiratory failure, and weight loss of the body. If the lymph nodes are infected, they increase in size, and after slaughter, tuberculous changes are found in them. With localizations in the intestine, the disease develops as a chronic inflammation of the intestine. This case is described in more detail when considering avian tuberculosis.
avian tuberculosis. Tuberculosis in domestic birds is caused by the avian form of tuberculosis, but they are also susceptible to other types of microbacteria. Birds kept in the apartment of a TB patient can become ill with human or bovine type TB. Infection occurs less often by aerogenic means and more often through the digestive tract, since the pathogen comes with grain, which can be grown in a natural focus on soil fertilized with the droppings of sick birds. In birds, tuberculosis occurs in a generalized form; lesions are represented by miliary nodules in all organs (very small), which is a consequence of bacteremia. Waterfowl are very resistant to these types of infections and get sick extremely rarely, but the lungs of diseased individuals are much more affected than those of chickens. Tuberculosis of sheep and goats. In sheep and goats, the disease takes the pulmonary form of tuberculosis, which is characterized by a long progressive course. Animals lose weight, lose their appetite against the background of fever, shortness of breath and cough. Tuberculosis bacteria cells are usually absent in the mammary gland.
Tuberculosis in dogs and cats. The disease occurs in the pulmonary or intestinal form. Animals are oppressed, refuse to feed, lose weight, cough, their secretions are rich in pathogens. Dogs tend to contract the human form of TB and in turn become dangerous to humans. Tuberculosis was detected in 41 (11.6%) of 354 examined people who were in contact with 41 dogs that died from tuberculosis. Since cats with tuberculosis often affect the intestines and lungs, and sometimes the skin, they can also serve as a source of the causative agent for humans, sometimes very severe. So, Lewis-Johnson observed a 3-year-old boy who was bitten by a cat; a primary complex developed at the site of the bite, followed by generalization, meningitis, and death.
Tuberculosis in humans. Symptoms 
Human tuberculosis transmitted from animals has been studied for a long time. Repeated attempts have been made to classify the form of tuberculosis in humans, infected from animals in various natural foci, according to the manifestation and course. And in these cases, two stages can be distinguished in the development of the disease: the primary disease and the secondary, or tuberculosis of any organ. Regardless of how the pathogen entered the body - with air or food, primary tuberculosis is characterized by the formation of a primary complex. If infection with this type of infection occurred by an aerogenic route, then the primary complex includes one or more alveolar tuberculous nodules and inflamed regional lymph nodes.
The primary complex with pulmonary localization develops simultaneously with a violation of the general condition. The patient has subfebrile fever, mild cough, weight loss, asthenia, lack of appetite. Intestinal primary human tuberculosis, which occurs as a result of a large number of pathogens entering the digestive tract (most often in children with milk from sick cows), develops slowly, accompanied by mild fever, asthenia, mild abdominal pain, and diarrhea. In small children and infants, intestinal primary tuberculosis can manifest itself in the form of inflammation of the peritoneum, tuberculous peritonitis with a very severe course. Sometimes, depending on the type of immunity, the primary complex is localized in the tonsils.
The focus of primary tuberculosis either develops favorably until cured by resorption and calcification, or, conversely, spreads until the appearance of secondary tuberculosis or a localized process in any organ. The clinical manifestation of secondary tuberculosis depends on the localization of the infectious process. In the pulmonary form, a violation of the general condition, weight loss, lack of appetite, normal or subfebrile temperature, heavy breathing, shortness of breath, cough with copious sputum, saturated with pathogens, sometimes with blood, are noted; with large blood losses, this form of the disease is called hemophthysia.
The defeat of the lungs is characterized by the formation of nodules and cavities. Tuberculosis of the digestive tract appears as an intestinal form, which is characterized against the background of a violation of the general condition by diffuse pains in the abdomen, bloating, nausea, and diarrhea. Bowel changes lead to stenosis. In susceptible individuals If tuberculosis in humans is caused by a bovine pathogen, extrapulmonary forms such as meningitis, arthritis, or ganglionic tuberculosis are often observed, especially in children.
Prevention of tuberculosis
Prevention of tuberculosis consists in identifying and removing animal sources of pathogens, which reduces the incidence of human tuberculosis by approximately 10%. In some countries where animal tuberculosis has been eliminated, the risk of infection for humans has decreased, but sick people have become a danger as a source of infection for animals. Animal farms that are unfavorable for tuberculosis are dangerous due to the numerous sources of these types of infections for humans (cattle, pigs, birds, cats, dogs).
Infection of a person can occur in the natural focus of the disease through direct contact with animals and through consumed products of animal origin, so the prevention of tuberculosis should be aimed at identifying sick animals by periodically examining the livestock by reaction to tuberculin. Sick animals should be sent for slaughter. Their meat goes for technical utilization, and for fresh consumption - only after heat treatment in autoclaves and provided that the general condition of the animals before slaughter was good. Livestock buildings, equipment and machines used for feeding animals are disinfected with 20% bleach or 2% caustic soda. Manure, straw and excrement are burned. In poultry houses, disinfection is carried out repeatedly, especially on soil where the avian-type pathogen persists.
The employees of the disinfection group must be provided with protective clothing. Persons who keep dogs and cats at home should avoid too close contact with these animals, and in case of such contact, take serious hygiene measures. Prevention of tuberculosis also includes veterinary examination of all food products of animal origin. Livestock is also checked for the presence of infectious animal diseases in order to exclude them from the general herd. Milk is suitable for consumption after properly pasteurized, and eggs obtained from sick birds must be boiled in boiling water for 20 minutes. Animal care workers and veterinarians are periodically medically screened for tuberculosis. Of great importance in the prevention of tuberculosis is the sanitary-educational work among persons who may be exposed to infection.
Tuberculosis (from Latin tuberculum - tubercle) is an infectious disease that affects the lungs of a person with the development of general inflammation.
The disease is caused by three types of mycobacteria - human, bovine and intermediate.
Tuberculosis is a disease that affects not only people, but also animals - livestock (cows and other cattle), pigs, and chickens.
Historically, tuberculosis had a different name - in the Russian-speaking environment it was called consumption. This disease until the beginning of the twentieth century was incurable, and patients died for a long time, gradually "withered", their condition constantly worsened.
At the risk of tuberculosis today are people with weakened or insufficiently formed immunity - children, the elderly, and women. Carriers of mycobacteria, according to the World Health Organization, are more than 35% of the inhabitants of the Earth.
Today tuberculosis is curable, but every year up to two million people die from this disease. As a rule, death occurs in cases where the patient is unaware of his disease, refuses treatment, lives in a region where medicine is underdeveloped, or is not available to patients for economic reasons.
Reasons for the development of tuberculosis
Allocate the main cause of the development of tuberculosis - mycobacteria, as well as side (environmental conditions and the state of medicine).
So, most often tuberculosis is caused by:
- mycobacteria of the human type;
- bovine mycobacteria;
- mycobacteria of the intermediate type;
- mycobacteria of other types living in the environment (there are more than 70 types of them, and for the most part they have no epidemiological significance, and become aggressive towards humans only when the body itself is weakened, and environmental conditions contribute to the active development microbe).
For rural residents, the most common cause of infection is M. avium, a bovine mycobacterium. As a rule, patients suffering from immunodeficiency conditions are ill with tuberculosis.
The causative agent of tuberculosis is Koch's bacillus, named after the researcher who first described the bacterium and its effects on humans. the cell wall of Koch's bacillus consists of polysaccharides, due to which the mycobacterium is able to tolerate even the most adverse external conditions, as well as maintain stable dimensions. Mycobacteria are unable to move independently because they lack flagella.
Tuberculin (tuberculoproteins, specific proteins with antigenic function) is a part of Koch's wand. It is the antigenic function that provides increased sensitivity to the effects of this protein, and the lipid fraction adds resistance to the effects of acidic and alkaline environments.
Ways of infection with tuberculosis
Main paths:
- aerogenic (airborne);
- contact (with direct contact);
- alimentary (with violations of the absorption function of the digestive system in general and, in particular, the intestines);
- transplacental.
If the human body is healthy, then the elements of the respiratory system provide protection from the effects of any infections, including Koch's sticks. However, the slightest respiratory disease or a decrease in their protective function (for example, as a result of toxic exposure) leads to infection. Mycobacteria infect bronchioles, alveoli, etc., overcoming the natural protective barriers of the mucous membrane of the respiratory system.
Stages of development of tuberculosis
The first stage thus received the definition of latent microbism. At this stage, a person can be quite a long time - sometimes years. At the same time, if no immune responses to mycobacteria are formed at this stage, this leads to a sharp increase in the number of mycobacteria.
The second stage is determined with the spread of Koch's sticks into the lymphatic vessels, of which - into the lymph nodes, spreading throughout the body. This stage is called primary mycobacteremia. At this stage, the target organs are the lungs, adrenal glands, organs of the reproductive system, lymph nodes, epiphyses and metaphyses of bones, that is, all organs and tissues with a developed system of lymph and blood microcirculation. Phagocytosis develops in the affected areas.
The first to suffer are polynuclear leukocytes, the second - macrophages. The former die due to weak bactericidal protection, the latter lose their viability due to virulence factors. After the defeat of macrophages, the stage of incomplete phagocytosis begins - Koch's rod enters the space between cells, increasing the number of proteolytic enzymes there.
If phagocytosis is ineffective, mycobacteria begin to multiply intensively and already in an unlimited way. In turn, this leads to a decrease in density, liquefaction of tissues and, as a result, the progress of the disease. At this stage, tuberculous granulomas are already formed, growing from the foci of caseous necrosis. These are already specific signs of tuberculosis.
Tuberculosis symptoms
At the first stages, the disease may not manifest itself in any way, a long period may pass in the absence of specific symptoms. Or the symptoms may turn out to be “blurred” and it is almost impossible to make a correct diagnosis without a closer diagnosis.
The most common non-specific symptoms of tuberculosis are:
- signs of general intoxication of the body:
- rise in temperature while maintaining it for a long time at a slightly elevated level (more often - about 37 degrees Celsius);
- increased sweating, especially during night rest;
- various asthenic manifestations.
- gradual weight loss;
- lymphadenopathy (limited or generalized), that is, swollen lymph nodes, soreness of enlarged lymph nodes.
With the further development of the disease, the list of symptoms is replenished with a cough with sputum, pain in the chest (sometimes pain accompanies cough), catarrhal phenomena.
Risk groups, such specialists include:
- by profession:
- medical workers;
- food industry workers;
- on the basis of chronic diseases, patients who have confirmed:
- diabetes;
- immunodeficiency states;
- as well as those who are being treated with immunosuppressants (cytostatics and glucocorticoids).
Diagnosis of tuberculosis
Diagnosis of tuberculosis is the results of a comprehensive examination: first of all, an assessment of the clinical picture, laboratory and instrumental studies. The first to be examined are biological fluids, primarily sputum secreted when coughing.
The following sputum examination methods are used:
- bacteriological;
- molecular biological;
- serological.
During laboratory microbiological studies, mycobacteria are detected, their sensitivity to drugs that are commonly used to treat tuberculosis is determined. The latter is especially important for those patients who have been engaged in symptomatic self-treatment for some time, and therefore have resistance to a number of drugs, including antibiotics.
In addition to sputum, water from the bronchi and stomach (obtained by washing the latter), smears from the larynx, and pleural fluid are used for analysis. Bronchial lavage is an extremely unpleasant procedure, therefore it is carried out under local (and in some cases under general) anesthesia. During this procedure, saline is injected into the bronchi.
Also, PCR diagnostics has become quite widespread in large medical centers today. This type of laboratory research is based on the identification of the DNA of mycobacteria, which are isolated from samples of biological fluids. The polymerase chain reaction method allows you to quickly get results - after only five to six hours, and at the same time - at minimal cost. However, this method has not yet received wide distribution, in view of its innovativeness.
Of the hardware studies in the diagnosis of tuberculosis, the following are used:
- fluorographic examination (the main method of primary diagnosis of tuberculosis);
- x-ray examination;
- lung biopsy;
- pleural biopsy;
- bronchoscopy;
- CT scan.
If changes in the lungs noted during a fluorographic examination are detected, the patient is sent for an additional examination, during which the localization of the altered tissues is revealed, and the diagnosis of tuberculosis is confirmed or refuted. As a rule, the second stage of a hardware diagnostic examination is a chest x-ray.
With the help of x-rays, both the actual pathological elements and pneumofibrosis, pulmonary emphysema, and bronchial ecstasy can be detected. In addition, calcified foci of previously transferred or inactive tuberculosis are detected. More detailed information about the patient will be given by computed and magnetic resonance imaging.
Tuberculin diagnostics (mantoux test)
The first tuberculin in history was prepared by means of an aqueous extract from mycobacteria artificially grown in a test tube. It was made by Koch himself, from mycobacteria of human and bovine strains. Today, similar tuberculin is created in glycerin broth at a concentration of 0.00002 mg (PPD-S) to 0.00006 mg (PPD-L). This value represents 1 TU, that is, the international unit of tuberculin, giving positive reactions in 80 percent or more of those infected with tuberculosis, and at the same time does not cause too strong reactions. As a rule, a mantoux test includes 2TE, i.e., two international units of tuberculin, however, other dosages are also used, as well as other methods of testing for tuberculin sensitivity.
In particular, these are:
- subcutaneous Koch test;
- graduated skin test;
- protein-tuberculin test;
- eosinophilic tuberculin test;
- tuberculin titer analysis, etc.
Tuberculin diagnosis is essentially based on an analogue of an allergic reaction. Strictly speaking, the mantoux test is a delayed allergic reaction caused by the contact of the antigen (tuberculoprotein) with lymphocytes (cells of the immune system). After the introduction of tuberculin, lymphocytes are sent to the place of accumulation of the allergen, which, when interacting with tuberculin, create biologically active substances, or, more simply, form an inflammatory process in the reaction zone. Previously, it was believed that the inflammatory process that occurs with a positive mantoux test (resembling a papule in appearance) is similar to inflammation in the foci of tuberculosis development, however, in the absolute majority of cases, specific tuberculous inflammation does not occur with a mantoux test.
The mantoux test is usually carried out in the middle or upper third of the forearm, on the front surface. The development of a skin reaction to tuberculin is basically completed after 48 hours, and after 72 it is completed completely. Thus, if re-diagnosis is not planned, it is best to conduct an examination three days after the test.
The development of the Mantoux reaction occurs in this way. Already one and a half to two hours after the test, the appearance of a "lemon peel" is noted - resorption of the tuberculin subcutaneous sphere, and after another half an hour a pink spot is formed - the first skin reaction. After four to eight hours, most patients develop watery soft pink papules. After 12 hours, they reach their largest size. After 14-20 hours have passed, the early papule differentiates, the main papule stands out in color and density (still in the form of a small seal in the center). It is by the main one that it will subsequently be possible to evaluate the mantoux sample. A day later, the process of differentiation is completely completed, and two days after the mantoux test, a bright hyperemic spot with a clearly distinguishable papule in the center is easily visible in all diagnosed patients.
After three days, the process of reducing the size of the papule begins, after 96 hours it gradually shrinks. By itself, the papule completely disappears after a week, but the trace on the skin caused by pigmentation persists for several weeks (usually three to four), depending on the individual characteristics of the patient's skin, as well as on the nature of the reaction itself.
If it is necessary to conduct a repeated mantoux test, it is carried out in a different place, otherwise a pronounced reaction can lead to errors in diagnosis. In cases where the reaction occurs quickly and lasts for several weeks (“reaction ignition”), we are most likely talking about the fact that the introduction of tuberculin occurred at the same place where tuberculin diagnostics had previously been carried out.
The size of the papule diameter is estimated in millimeters. If the size is 5 millimeters or more, the sample is considered positive. If the diameter of the papule is at the border, ranging from three to four millimeters, a second test can be carried out on the other forearm, with a more concentrated solution (for example, if the primary test included 1 TU, then the secondary test included 2 TU). Determining the threshold of skin sensitivity to tuberculin - titration - includes several samples of mantoux in turn on different forearms to determine the minimum dosage at which a positive reaction is obtained, that is, a papule with a diameter of five or more millimeters.
If the sensitivity threshold for a sample with the amount of tuberculin 1TE is 19 millimeters or more, and for 2TE - more than 22 millimeters, not to mention such manifestations as lymphadenitis, lymphangitis, and vesicles indicate hyperergy, that is, increased tuberculin sensitivity . In adolescents, this is evidenced by the size of the papule more than 17 mm. In turn, the size of the papule up to 19 mm on 1TE and from 8 to 22 mm on 2TE are called normergic.
For mass diagnostics in domestic practice, solutions containing tuberculin 2TE are usually used.
The results of the mantoux test can also be affected by both external and internal factors. Thus, in women, the result of the reaction is usually more pronounced (especially in the postpartum period, as well as in women who are overweight or prone to fullness), and with age, this increased sensitivity to tuberculin decreases very slowly. But during menstruation and during pregnancy, the mantoux reaction is inhibited. In turn, when diagnosing men, it must be borne in mind that their skin reactions are weaker, and with age they noticeably decrease. With age, the reactivity of the skin decreases (moreover, in men - to a greater extent), besides, the role of the supporting antigenic effect of infections decreases in them.
According to some researchers, sensitivity to tuberculin increases significantly in the spring and decreases in the autumn. Changes in sensitivity to tuberculin also have occupational causes. So, chemists, textile workers, specialists dealing with synthetic rubber, lead and chromium show more pronounced reactions.
To reduce the tuberculin reaction lead to:
- malnutrition;
- chemical and thermal burns;
- foci of inflammation on the skin;
- skin manifestations (psoriasis, acne, etc.);
- dry skin;
- venous hyperemia;
- hypothyroidism;
- alcoholism;
- measles;
- avitaminosis (especially - lack of vitamin C);
- long-term high body temperature;
- X-ray exposure in medium and high doses;
- the use of a number of pharmaceuticals (norsulfazole, penicillin, iodine, antihistamines, pyridoxine, rutin, bromine, butadione, iron-ascorbic acid, glucocorticosteroids);
Tuberculosis treatment
Tuberculosis is treated only by qualified doctors and in a specialized tuberculosis hospital.
The treatment regimen, depending on the severity of the disease, includes to a greater or lesser extent the following blocks:
- daily regimen and motor regimen (bed rest, sparing regimen or training regimen);
- diet and diet;
- drug therapy;
- natural and hardware physiotherapy;
- in especially severe cases - surgical treatment.
Anti-tuberculosis drug therapy makes it possible to achieve a tuberculostatic effect, or, in other words, to reduce the activity of mycobacteria and their virulence, to suppress their reproduction. It is especially important to carry out treatment in a complex and rational way, eliminating not only the symptoms of the disease, but also curing it. An ill-conceived treatment policy, in turn, can lead to the transfer of tuberculosis into a chronic form.
The main anti-tuberculosis drugs (tuberculostatics):
- isoniazid and its derivatives;
The duration of the course of treatment depends on the age, weight and condition of the patient. The minimum effective daily dose of the drug - 0.3 g - is usually prescribed for elderly patients, as well as patients weighing less than 55 kilograms. As a rule, the daily dose of this drug is 0.6 g. Isoniazid (tubazid) is used in the vast majority of cases in combination with other drugs, the only exceptions are patients with allergies to other specialized anti-tuberculosis drugs.
- streptomycin and its derivatives;
Complex anti-tuberculosis drugs based on streptomycin are widely used to treat patients of any age and weight. The minimum effective daily dose of the drug is 0.5 g (for elderly patients and patients weighing less than 55 kilograms), for middle-aged and more impressive people - from 1 g daily. It is used both as an intramuscular agent and as an aerosol for inhalation (based on saline).
Separately, it should be noted Streptosaluzid - a drug that is complex in itself and combines streptomycin and saluzide. As a rule, this drug does not require the additional inclusion of other drugs in the treatment regimen.
- PASK;
For monotherapy, PAS preparations are not used - only in combination with isoniazid or streptomicides.
- combination drugs.
Additional anti-tuberculosis drugs:
- kanamycin;
- ethionamide;
- cycloserine;
- ethambutol;
- rifampicin
This semi-synthetic antibiotic, which acts specifically on mycobacteria - reducing their activity, preventing their reproduction - is quite easily excreted in the patient's urine, and therefore is used both for pulmonary and urogenital tuberculosis. The daily dose per 1 kilogram of the patient's weight is 10 mg.
Combination therapy, which includes drugs from different therapeutic groups, simultaneously solves several problems. This includes controlling the patient's intake of drugs (which is especially important for those patients who avoid treatment), and reducing the drug resistance of mycobacteria, and slowing down their development, and, in general, achieving a positive therapeutic effect.
The routes of administration of most drugs are intramuscular, intrapleural, inhalation, tracheobronchial.
Pulmonary tuberculosis
Tuberculosis is an infectious chronic disease in which tubercles (specific nodules) are formed in the tissues and organs of the body, prone to caseous decay.
Pathogen.
Mycobacterium tuberculosis is a tubercle bacillus. A feature of this pathogen is that the shell is impregnated with fat and wax substances. Therefore, this pathogen is referred to as acid-alcohol-ether-resistant microorganisms. The causative agent is rod-shaped, does not form capsules and spores, aerobic, immobile. There are 3 types of tuberculosis pathogens: human (Mycobacterium tuberculosis humanus), bovine (Mycobacterium bovis) and avian (Mycobacterium avium). According to their morphological properties, all three species are the same, but they have differences in antigenic properties. The pathogenicity of different types of pathogen is not the same. So, to the causative agent of bovine tuberculosis, humans, all agricultural and wild animals are susceptible. Pigs are sensitive to avian, rarely humans and other mammals, but dogs, cats, parrots, pigs and cattle are also susceptible to the causative agent of human tuberculosis.
Epizootology.
Tuberculosis affects all types of animals, some species of birds, and humans. It can proceed in open-active (when bacilli have access to the external environment) and closed-latent (involves isolation of bacilli inside the body) forms. Infection, as a rule, occurs alimentary or aerogenic, and possibly congenial or congenital (through the placental circulation). Sometimes there is infection with male infected sperm of the mother's egg. The causative agent is localized in organs and tissues, forming tuberculous foci. Especially often tuberculous foci are formed in the lungs, intestines, udder, liver, uterus, kidneys, spleen. The source of the disease is sick animals that excrete the pathogen into the environment with sputum, urine, feces, milk, semen. A contributing factor is a violation of the conditions of feeding, maintenance, lack of exercise.
The most susceptible to infection is cattle, followed by pigs, horses, goats, carnivores (cats, dogs) and rabbits, sheep are not very susceptible to tuberculosis. Of the poultry, chickens are the most susceptible, while geese, pigeons and ducks are the least affected.
Pathogenesis.
At the site of the introduction of the pathogen, an inflammatory process begins to develop, multinucleated giant and epithelioid cells accumulate around the mycobacterium, they, in turn, are surrounded by a dense layer of T-lymphocytes. Exudate accumulates in the intercellular space, coagulating into a fibrin network, thus forming a tubercle or an avascular tuberculous nodule. Then, a connective tissue capsule begins to form around the tubercle, inside which, due to the lack of nutrients, as well as under the influence of toxins of the pathogen itself, the cells begin to die and turn into a crumbly dry mass. Further, with a sufficiently strong immunity, either healing and scarring occurs, or the deposition of lime salts with further decalcification of the nodule occurs. If the body is not strong enough, there is a melting and fusion near the lying nodules, which leads to the formation of larger nodes. From tubercles, bacilli enter the bloodstream, which leads to a generalization of the process and the development of tuberculosis in the liver, kidneys, spleen and other organs.
Symptoms.
Tuberculosis is mostly asymptomatic. The incubation period lasts from 14 to 40 days. Clinical signs appear only in the later stages of the disease.
With pulmonary tuberculosis, a cough is noted, at the beginning it is rare, strong, short-lived, and when the process worsens, it is silent and painful.
appetite and productivity decrease, the temperature rises, the skin loses its elasticity.
With intestinal tuberculosis, chronic diarrhea appears, accompanied by bloody, sometimes purulent, fetid discharge. Diarrhea alternates with constipation. There are intermittent colic.
Tuberculosis of the udder is primarily recognized by the enlargement of the supra-udder lymph nodes. The posterior lobes are affected first. On palpation after peeling, painless seals are found. Over time, the process spreads to the entire udder. Watery milk with casein flakes. The process is almost always open.
In a bird, egg production is disturbed, eggs are unformed, intestinal upset is observed, and atrophy of the muscles of the chest.
Dogs and cats get tired quickly and often lie down. When the lungs are affected, coughing and shortness of breath are observed. In some individuals, after feeding - vomiting. The animal is depressed, there is no appetite. Perhaps an increase in submandibular lymph nodes, dropsy of the abdominal cavity.
pathological picture.
Tuberculous changes are most often detected in the lymph nodes, lungs, on the serous integuments of the chest and abdominal cavities, in the intestines on the mucous membrane of Peer's plaques and solitary follicles as separate ulcers with a gray-white bottom. Tuberculous foci contain a cheesy gray-yellow mass. Bronchial, mediastinal and mesenteric lymph nodes are sharply enlarged, on the incision dotted with foci with curdled or purulent contents.
Diagnosis.
It is established on the basis of anamnestic, epizootic data, clinical signs, as well as laboratory tests and autopsy.
Laboratory studies include allergic and bacteriological research methods.
Bacteriological studies are carried out to determine open forms of tuberculosis, and to determine the pathogen. For research, depending on the symptoms, bronchial mucus, feces, urine, discharge from the genital organs, milk are taken.
Tuberculin is used for allergic research.
Cattle tuberculin is injected intradermally into the middle third of the neck, calves into the shoulder blade. With a positive reaction to tuberculosis, a hot diffuse swelling is formed. Skin thickness increases by 3 mm or more. In an eye test, tuberculin is injected into the conjunctival sac. With a positive reaction in the animal, reddening of the conjunctiva, swelling of the eyelids, photophobia, and mucopurulent outflow from the corner of the eye are noted. The bird tuberculin is injected into one of the earrings. With a positive reaction to tuberculosis, the earring swells and resembles a bloody drop.
- Subcutaneous method of tuberculinization in dogs and cats can identify up to 60% of sick individuals. Tuberculin is injected into the area of the inner surface of the thigh. The result is evaluated after 48 hours.
Treatment.
Effective and reliable methods of therapy for animal tuberculosis have not been developed. Various regimens may require treatment for up to 2 years. Therefore, quite often, sick animals are euthanized. But do not forget that good feeding conditions make animals more resistant to this infection!
VIDEO:
Tuberculosis has many faces. After all, not only we bipeds suffer from consumption, but also cows, and camels, and chickens, and other domestic and wild animals, from elks and wild boars to sparrows.
There are several types of Koch sticks. Some cause the so-called bovine tuberculosis, others - avian, others - human. The trouble is that all three species are dangerous and destructive for people, and all of them can be transmitted to him from a sick creature. Cows are only susceptible to bacillus bovine and human tuberculosis. And among chickens and all the winged brethren, to which pigs suddenly joined, the situation is even more enviable: they themselves become infected with only one bird species, although they can be carriers of any.
INSIDENT STICKS
Tuberculosis is not a trifle. Even those who have recovered carry its trace throughout their lives. By the way, the first meeting with Koch's bacilli, usually in early childhood, mostly ends well, since all children in the maternity hospital are vaccinated, and the immune system copes with the infection. The child becomes infected, but does not get sick. True, the sticks do not disappear, do not leave the body, but remain in it, as it were, in a walled-up form, and sometimes they remain viable until the last days of a person. If he is greatly weakened due to some kind of illness, or old age has sharply reduced immunity, or someone has consumption nearby, then the bacilli can become more active, increase their numbers, and the person becomes ill.
Bovine tuberculosis is more insidious and merciless than human. More insidious because sometimes elusive. Actually, the human form of tuberculosis is also not so easy to recognize in time: it is easy to confuse it with the common cold and many other ailments. However, Koch's sticks are still most often introduced into the lungs. The lungs, thanks to X-rays, are accessible to the medical eye. Bovine tuberculosis often proceeds secretly, it is extrapulmonary, for example, osteoarticular, glandular, genitourinary, and affects such organs and tissues that are inaccessible either to the beam or to the eye.
Bullish form and flows harder than a human. And it's harder to treat. How can this be explained? The fact that the painful process develops very quickly. And the bovine Koch sticks are two to three times more resistant to anti-tuberculosis drugs than their counterparts (why this is the case is not yet known for certain). Therefore, the therapy here is special: it does not tolerate the usual gradualness - incremental movement. On the contrary, we need an urgent frontal attack - we have to immediately mobilize the most powerful and effective means. And the treatment is much longer.
It turns out that where tuberculosis has many faces, it is not enough to find Koch's bacillus in a patient. We still need to recognize her appearance. In what way?
Under the microscope, the causative agents of all types of tuberculosis look the same, it is impossible to distinguish them. Until the mid-1960s, the biological typing method was mainly used, based on the different sensitivity of laboratory animals to various types of tuberculosis bacteria. It was both expensive and complicated and time consuming.
Therefore, the world was constantly searching for more acceptable methods. They were found. American K. Konno developed the so-called niacin test. Its idea is simple: compared to bovine tuberculosis bacilli, they produce more nicotinic acid - niacin - in the nutrient medium. If chloramine-B is added to the culture in the presence of potassium cyanide, then it will turn bright yellow.
The method is inexpensive and reliable. Only one "but": potassium cyanide. A powerful poison that requires careful storage and careful handling. Biochemists came to the rescue. As it turned out, potassium cyanide can be successfully replaced by safe barbituric acid. Now the reliable test is both public and harmless.
HOW TO BREAK THE CIRCLE
So, all over the world, people mostly suffer from the human form of tuberculosis. And the infection is transmitted mainly along the "human" chain: from the sick to the healthy. In order to become infected, one must have close and long enough contact with the sick person. But in places where cattle are sick, the infection will certainly be transmitted from animals to people. And vice versa, if a sick shepherd or cattleman continues to care for healthy cattle. One farmer from Germany, not noticing a latent form of the disease, infected 48 cows in a short time. Such cases are not isolated. So the vicious circle can close.
The history of getting rid of bovine tuberculosis in developed countries is very instructive. According to statistics on the spread of this type of disease in the world, collected by two German specialists, in the first post-war decade - until 1954 - every tenth tuberculosis patient on our planet suffered from the bovine form. In the early 1950s, it occurred in almost every third Swiss and German with consumption, almost every fourth Australian, eighth Hungarian, etc. Why are the numbers so high? The reason is World War II. It undermined the economic and fodder base in many countries.
Farm animals were malnourished, sometimes lived in cold and cramped conditions. That is why tuberculosis infection spread among them. In 1946, up to 40 percent of livestock were infected in England, in 1950 the same number in Germany, 25 percent in Austria and Italy, and about 18 percent in Holland. Only one and a half to two decades have passed, and in many countries of the world tuberculosis of cattle no longer exceeds one percent. And by 1977, 17 out of 27 European countries were completely free from it.
In the Soviet Union, by the end of the 60s, in nine union republics it was possible to bring it to an extreme and, in general, safe minimum, and in two republics it was completely eradicated.
Looks like we can put an end to this problem. However, both foreign and domestic experience convinces: half-measures are not good. There is only one way out - without delay to send to the slaughterhouse absolutely all sick and infected with bacilli animals. Then there will be a no less decisive and time-consuming procedure - to disinfect not only cowsheds, stables and barns, but also cattle yards, and even pastures. After all, tuberculosis bacilli are truly all-pervading and surprisingly resilient. They are not afraid of either 30-degree frosts, or drying, or acids, or alkalis, or alcohol. That is, everything that is deadly for most of their "colleagues" - pathogenic microbes. In a dried state, they can live in a dimly lit room, even just in the corner of a room, up to 120 days, on glass - up to 220 days, in linen that is stored in a closet - 330 days. On the blades of grass that sick cows nibbled, with the saliva of animals, bacilli are sure to fall, retaining their strength for a month and a half, and if they penetrate the soil, then a year.
But all records are broken by the causative agents of consumption, which are found in the manure of tubercular animals. Their pathogenicity can persist for ten years. Manure is used not only as a fertilizer, but also as a fuel and as a building material.
How to deal with destructive sticks? They are afraid of direct sunlight, boiling, prolonged heating at high temperatures. They also cannot stand some disinfectant solutions - in particular, chloramine, formalin, bleach. This is what they use, spraying with disinfecting compounds and watering places for animals, and the meadows where they grazed, and the ground around the cowsheds, and the cowsheds themselves, including walls, windows, ceilings and even lamps under the ceiling. For months, manure, hay, and fodder grain are roasted under the direct and scorching rays of the sun. And if this is not possible, manure - a clear breeding ground for infection - is destroyed. In a word, everything that is possible is disinfected, boiled, calcined, translucent, planed, painted, etc. And only then the treated and renovated premises are populated with healthy livestock.
Why is tuberculosis strong precisely in the east of the country - in some regions of the Volga region, the North Caucasus, Siberia, the Urals, and especially in the semi-deserts of Central Asia and Kazakhstan? And why in these parts his strength in the countryside is felt much more clearly than in the cities?
Experts are convinced that in today's Siberian, Ural, Kazakh, Kyrgyz village there are too many, as they say, risk factors, that is, conditions that contribute to the development of consumption. Still, the local villagers have a much harder time both at home and at work than the townspeople. In addition, they often deal with pesticides, aerosols, all kinds of dust, which does not have the best effect on the body.
Suffice it to recall the unkindness of the trans-Ural plains. For three days the train took me from Moscow to Alma-Ata, almost two of them - through the Kazakh steppe. Ascetically severe, almost monochromatic, sometimes as if frosty from the salt coming out of the soil, with prickly tussocks to the horizon and lonely knotty elms. In a long dry summer, literally everything has a grayish-yellow coating. This ubiquitous microscopic and almost weightless loess dust is an excellent medium for the transfer of tubercle bacilli.
However, dust is one of the details. The sharply continental Siberian-Asian climate is especially acutely felt by the villagers, plus the lack of water and any vegetation. In a word, there are many circumstances that reduce the immune status of the body. He ceases to resist tubercle bacilli, and they are always next to a person. The danger increases even more if farm animals are sick.
TB AND HEALTH CULTURE
At the very beginning, we said how criminal the figure of silence in relation to tuberculosis is. How many people know about consumption? Ignorance about it is sometimes downright frightening. Especially among citizens who just live in areas where this disease is rampant. Here, for example, are the results of a survey of village residents of Altai in 1987. A third of those surveyed had no idea that TB was contagious. Moreover, some of them had completed secondary and even higher education. One quarter knew nothing about the prevention of the disease, that is, the existence of vaccinations and preventive treatment. And only half of the respondents knew about tuberculosis in domestic animals and that it is transmitted to people. The picture is very typical.
Today, a person knows much more about what is happening, say, in space or in the Askania-Nova reserve, than in his own body. Hence the thoughtless attitude to their health. But where do you get knowledge? From leaflets written in official language? From edifying lectures? Of the correct, but similar to each other, boring San Education films, which, by the way, are still few?
Our medical propaganda has not justified itself - now it is obvious to everyone. It is unconvincing, formal. Apparently, it makes sense to reorient it from education to medical education. And it has to start at school.
By the way, the epidemiologists of the Kazakh Research Institute of Tuberculosis once went on a similar experiment. Working in the villages of the Kzyl-Orda region and trying to familiarize local children with knowledge about tuberculosis, they began to conduct dictations on this topic in primary classes. The effect was amazing. School kids - an emotional audience, very receptive and very persistent in their desires - not only learned the knowledge themselves, but, as they say, carried it to the people: parents, relatives, acquaintances. The children did not calm down until the adults came to the outpatient clinic for x-rays and preventive examinations, and sometimes they dragged the elders almost by force to see the doctor.
However, not only in school educational program is medical education. The problem is clearly not within the power of one physician. We need both special knowledge, and a journalistic gift, and taking into account the spiritual characteristics of people. There is a need for integration with psychologists and sociologists, a kind of health pedagogy designed for people of all ages and levels of education. And, of course, the strategy of medical education cannot be the same in different Union republics. After all, one has to deal with folk customs and traditions. How to keep tact? From whom to learn to conduct business psychologically subtly, so as not to offend the national feeling of a representative of this or that people?
In a word, the time has come for genuine publicity regarding consumption and other "closed" infections. Glasnost not in itself, but for the sake of eliminating ignorance. To foster a culture of health. Without this, tuberculosis cannot be defeated.
Bible - New Testament
Psalter - Old Testament
Infection of humans with Mycobacterium bovine tuberculosis was formerly very common in England and Europe due to the large infestation of cattle and infection of humans through milk. Cattlemen also sometimes become infected by the respiratory route. Cats and dogs are susceptible to the disease through contaminated milk from cows or from humans. It is difficult to say whether they in turn infect a person.
Mycobacterium tuberculosis of the bovine type is as virulent in humans as it is in the human type. Bacteriologically, they differ in three ways:
1) Mycobacteria of the bovine type grow faster, and human, more slowly in the presence of glycerol. Since the latter is used in conventional cultures, bovine mycobacteria can be suspected by dysgonic growth.
2) Mycobacteria of the bovine type are highly virulent for the rabbit; human-type mycobacteria cause only local lesions.
3) All human type strains are niacin positive, usually to a high degree, while bovine type give only a weak reaction, and "anonymous" mycobacteria, with rare exceptions, are negative.
Type of disease. In the past, tuberculosis caused by bovine mycobacteria was often extrapulmonary, since infection through milk naturally occurred more often in childhood. Due to the age of infection, hematogenous tuberculosis was common. When infected through milk, the tonsils were primarily affected with a glandular component in the cervical lymph nodes, or the intestines with a glandular component in the mesenteric lymph nodes and sometimes secondary abdominal tuberculosis. Due to the route of infection, pulmonary tuberculosis was uncommon unless it occurred hematogenously or by direct contact with cows.
value at present. By the end of 1960, all cow herds in England were declared free from tuberculosis, although there were occasional breaches of control and minor epidemics. Mycobacterium bovine tuberculosis is still occasionally isolated from older, previously infected patients, usually from lesions of the cervical lymph nodes or kidneys. In a national survey in England in 1963, bovine mycobacteria were obtained in cultures from 0.2% of newly diagnosed patients with respiratory tuberculosis and over 1% of cases in rural areas of Western Scotland in 1963-1965. . Bovine tuberculosis has been completely eliminated in all Scandinavian countries, except for relapses of an old disease, but it is still an important, albeit declining, problem in many other European countries. It has indeed been eliminated in North America. Bovine tuberculosis is considered irrelevant in most tropical and developing countries, either because they do not drink milk or because if they drink it, they boil it first.
Methods for determining the risk of bovine tuberculosis to the population. With regard to bovine tuberculosis, two organizational measures are being carried out in many countries: pasteurization of milk and the creation of "certified" herds of tuberculin-negative cattle. In the UK, the latter was achieved through financial support to farmers, free tuberculin testing and the slaughter of tuberculin-positive cattle in the later stages of the campaign.
