Unfortunately, There Are Many Undisciplined Patients

Unfortunately, there are many undisciplined patients

According to the WHO, a third of the world's population is infected with mycobacterium tuberculosis, and every tenth infected person falls ill. About the first symptoms of the disease, methods of diagnosis and treatment, as well as what untreated tuberculosis leads to, the chief freelance specialist-phthisiatrician of the Russian Federation, director of the Research Institute of Phthisiopulmonology of the I. M. Sechenova Irina Vasilieva.

According to the WHO, a third of the world's population is infected with mycobacterium tuberculosis, and every tenth infected person falls ill. About the first symptoms of the disease, methods of diagnosis and treatment, as well as what untreated tuberculosis leads to, the chief freelance specialist-phthisiatrician of the Russian Federation, director of the Research Institute of Phthisiopulmonology of the I. M. Sechenova Irina Vasilieva.

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In a previous conversation, Professor Vasilyeva told Mednovosti about what contributes to the spread of tuberculosis, and about positive trends in taming the infection, and also described the portrait of an average Russian patient.

Irina Anatolyevna, what are the first signs of tuberculosis, what should alert you and become a reason to see a doctor?

- It can take more than one year from the moment of infection to the disease. The very first symptoms are completely unremarkable and are characteristic of many diseases - unreasonable weight loss, lack or decrease in appetite, weakness, and malaise. Later, night sweats, more specific for tuberculosis, appear, and there may be a slight increase in temperature, which patients often do not notice. And here you should get seriously worried and go to the doctor. Even if the temperature rises to 37 with a little and not every day, but once every two weeks. And if a cough that lasts three weeks is added to this, then you should already run to the doctor at a run. A cough occurs with various diseases, but in the case of tuberculosis, it indicates that this is a far-advanced stage, and possibly already contagious.

Can a local therapist make a diagnosis?

- Not always. The diagnosis is not easy, but still depends on the phase of the disease. With the initial, non-infectious form, diagnosis is very difficult - as long as there is no cough with sputum production, then there is nothing to investigate. The X-ray shows changes in the lungs, but you need to figure out what these changes are. For this, they resort to instrumental diagnostics - a bronchoscopy with a biopsy is performed for a special study. If this is already an advanced stage, with the decay of lung tissue, when there is a cough and sputum, then it is examined for the detection of tuberculosis pathogens. The analysis is performed several times - at least twice. In this case, the sputum should be examined by three methods - microscopic, molecular genetic and culture method.

And if earlier the culture had to be grown in a test tube for three months, now, thanks to new techniques, this period has been reduced to three weeks. And molecular genetic diagnostics allows you to identify fragments of Mycobacterium tuberculosis within a few hours. In addition, these methods provide information about the resistance of the disease to drugs, which makes it possible to treat the patient in a targeted manner from the very beginning of the therapy course.

And the Mantoux test?

- The Mantoux test is a screening, not a diagnostic method. And this test is not carried out in adults, but is used to detect the infection of children - in order to take the necessary preventive measures. Even short-term contact with a sick person is dangerous for a child.

Today, another method of screening observation with the help of tuberculin skin tests has appeared - Diaskintest. The new skin test is more specific than the Mantoux test, which reacts to both the tuberculosis infection itself and the vaccine (post-vaccination allergy), and sometimes to another infection present in the body. The Mantoux test is very sensitive, but it gives many false positives. But Diaskintest gives an answer only to the tuberculosis infection itself, and this is its value.

The screening method for adults is a fluorographic examination. Well, then specific diagnostics already begin. Today, the only way to detect tuberculosis on time, which means that it can be cured faster, is to undergo regular screening tests.

And if it is extrapulmonary tuberculosis?

- With this it is even more difficult, and here specialists are following the path of excluding other diseases. And the diagnosis of various forms of tuberculosis is largely based on clinical symptoms. For example, in osteoarticular tuberculosis, there are specific changes in the bones that a competent radiologist or orthopedic traumatologist can notice. The tuberculous nature of meningitis is established by the analysis of cerebrospinal fluid. Tuberculosis can develop in any other organ, even the skin, with the exception of the hair.

How are tuberculosis patients treated?

Treatment is always complex, and it is based on anti-tuberculosis therapy. Such therapy means long-term daily use of a combination of anti-tuberculosis drugs, at least four. In no case should you limit yourself to one or two drugs - drug resistance will develop. And with drug-resistant forms of tuberculosis, when the proven standard scheme does not work, 5-6 drugs are required.

All drugs necessary for effective fight against tuberculosis were created in the 50-70s of the last century. However, a few years ago, WHO registered two new anti-tuberculosis drugs. Tuberculosis is treated well, but it takes a long time. With the usual standard forms of tuberculosis, at least six months of such therapy is required. With drug-resistant forms - one and a half years.

What are the causes and main difficulties of drug resistance?

Today, multidrug resistance is one of the main problems of phthisiology. Koch's wand mutated and became resistant to the most effective drugs. Drug resistance also develops when the patient does not comply with the prescribed regimen and doses of drugs or interrupts treatment. Under these conditions, mycobacteria are able to develop resistance. If all patients withstood the prescribed treatment, then we would not have so many patients with drug-resistant tuberculosis.

Unfortunately, there are many undisciplined patients: it takes a year and a half to be treated, but the state of health very quickly improves against the background of treatment, and the person stops taking medications. This is dangerous not only for others, but also for himself. For a while, the disease subsides, but when an exacerbation occurs, it is much more difficult to treat it.

Another variant of drug resistance is associated with the fact that a person becomes infected with an already resistant mycobacterium. And resistant mycobacteria are spread by patients who interrupt treatment, or chronic patients. And such cases, unfortunately, are increasing every year.

What happens to those who are not treated at all?

There is a small percentage of cases of self-healing. Sometimes this is possible, with the so-called minor form. Usually people do not feel that they are sick, the immune system copes, and the local form does not result in a major disease. We already see traces of tuberculosis in the form of calcifications in the lung tissue in the photographs after the fact.

But in most cases, the patient dies without treatment. The disease can develop for a long time, and on average, a person can live for three years without treatment. With strong immunity - a little longer. With a weak, especially if it is HIV infection, the patient dies much faster. Therefore, we always urge the patient to immediately begin treatment, and if he is contagious, be sure to be hospitalized in a dispensary, where he will be prescribed full treatment and temporarily isolated from the family at risk of infection.

How can you protect yourself and your loved ones from tuberculosis?

- Basic principles of prevention: lead a healthy lifestyle and avoid contact with sick people who cough and spread infection. A healthy adult must get enough sleep, eat right, and, picking up a seasonal infection or other disease, not work, but how to lie down and be treated properly. If in your environment there is a long-term coughing person, then you need to draw the attention of the patient himself and his relatives to this, explain that he should be examined.

If an adult is at risk, for example, sick with a chronic disease weakening the immune system, then he must undergo annual fluorographic examinations. The fact is that, for example, patients with diabetes mellitus, according to the WHO, get sick with tuberculosis 4-5 times more often. People with HIV infection, whose risk of contracting tuberculosis is 30-40 times higher, should undergo fluorography twice a year. And besides, HIV-infected people cannot refuse preventive treatment with anti-tuberculosis drugs.

As for children, firstly, the vaccination, which is done in the hospital (revaccination is carried out at the age of seven), can make them safe. And secondly, screening observations using tuberculin skin tests, in order to detect infection in time.

Many Western countries have already given up vaccination, and this is justified because they have a low incidence. But in countries with a high incidence, vaccination is very important - BCG vaccination does not completely protect against tuberculosis, but prevents the development of severe, fatal forms in children. So far, a better vaccine than BCG has not been invented. And it is very important that parents understand how dangerous it is to refuse to vaccinate young children immediately after birth.

Why is it necessary to vaccinate in the hospital, why such a rush?

- Because, leaving the hospital, the child finds himself in an environment in which he is not protected from meeting an infection. And it is better that before discharge from the hospital, he has already received this vaccine. Then another three months are spent on the development of the immune response. Of course, there are times when a newborn child has contraindications for vaccination. And then, when he grows up, before the vaccine is administered, the child is given a skin test to find out if he has already caught the infection. If you do not catch it, then they are vaccinated, but otherwise the vaccination is already useless.