Pulmonary tuberculosis

Pulmonary tuberculosis is an infectious disease caused by mycobacteria, most often Mycobacterium tuberculosis. This disease primarily affects the lungs, although it can also affect other organs. Tuberculosis is characterized by chronic inflammation of the lung tissue, the formation of granulomas and caseous necrosis. The infection is transmitted by airborne droplets, which makes it especially dangerous in conditions of mass concentration of people. Symptoms of the disease include prolonged coughing, sometimes with expectoration of blood, fever, night sweats, weakness and weight loss. It is important to note that pulmonary tuberculosis can manifest itself in various forms - from latent to acute, which requires an individual approach to diagnosis and treatment.

History of the disease and interesting historical facts

The history of tuberculosis goes back thousands of years. Some archaeological finds indicate the presence of the disease in ancient Egypt. In the 5th century BC, Hippocrates described symptoms similar to tuberculosis. In the Middle Ages, tuberculosis was called "consumption" due to its association with severe exhaustion of patients. Interestingly, in the 19th century, tuberculosis reached epidemic proportions in Europe and became a symbol of romanticism in literature. The discovery of antibacterial agents in the 20th century, such as streptomycin, although significantly reduced the incidence of the disease, the proportion of resistant forms of the infection continues to be a constant threat to health.

Epidemiology

According to the World Health Organization (WHO), tuberculosis is one of the leading causes of death from infectious diseases in the world. As of 2021, there were more than 10 million cases and about 1.5 million deaths due to tuberculosis. Most new cases are observed in countries with high poverty rates and weak health infrastructure. In Russia, the incidence rate also remains high, especially among risk groups such as people living with HIV, former prisoners and drug addicts. Various factors such as migration, deteriorating living conditions and the development of drug resistance continue to contribute to the spread of the disease.

Genetic predisposition to this disease

Genetic factors play an important role in a person’s susceptibility to tuberculosis. Research shows that certain genes responsible for the immune response can increase or decrease the risk of developing the infection. For example, mutations in genes such as NRAMP1 and TLR2 can affect the body’s ability to effectively control the reproduction of Mycobacterium tuberculosis. Additionally, polymorphisms in genes responsible for the production of cytokines can become predisposing factors for the infectious process. These studies open up new horizons for the development of personalized approaches to the prevention and treatment of tuberculosis.

Risk factors for the development of this disease

Risk factors for tuberculosis can be divided into several categories:

• Social factors: poverty, lack of education, poor housing conditions, social isolation.
• Medical factors: presence of chronic diseases (eg, HIV, diabetes), immunosuppression, previous infections.
• Environmental factors: air pollution, contact with tuberculosis patients, advances in the treatment of other infectious diseases (changes in microbial growth patterns).
• Occupational factors: work in healthcare facilities, penitentiary institutions and homeless shelters, where the likelihood of contact with patients with active TB is high.

Given these factors, it is important to apply a comprehensive approach to the prevention and control of tuberculosis in the population.

Diagnosis of this disease

Diagnosis of tuberculosis includes several stages and methods:

• Main symptoms: persistent cough, weight loss, loss of appetite, night sweats, fever.
• Laboratory tests: sputum microscopy, culture on nutrient media, PCR to detect specific genes.
• Radiological examinations: chest X-ray, computed tomography to detect characteristic changes in lung tissue.
• Other types of diagnostics: allergy tests (Mantoux test, IGRA tests), blood tests for the presence of specific antibodies.
• Differential diagnosis: exclusion of other infectious lung diseases such as pneumonia, tumors, sarcoidosis.

Accurate and timely diagnosis is a prerequisite for successful treatment and prevention of complications.

Treatment

Treatment of tuberculosis requires a multi-component approach and includes:

• General treatment: creating favorable conditions for recovery, supporting immunity, preventing superinfections.
• Pharmacological treatment: The standard regimen includes antibiotics such as isoniazid, rifampin, pyrazinamide and ethambutol.
• Surgical treatment: in cases where tissue delamination or cavities require surgical intervention (eg, lung resection).
• Other types of treatment: physiotherapy, vitamin therapy, immunotherapy (at the research stage).

Only a comprehensive approach to treatment can achieve high rates of recovery and reduce the risk of relapse.

List of medications used to treat this disease

List of essential anti-tuberculosis drugs:

• Isoniazid (H)
• Rifampicin (R)
• Pyrazinamide (Z)
• Ethambutol (E)
• Streptomycin (S)
• Kanamycin
• Flucutosine
• Linezolid

The effectiveness of treatment depends on the correct choice of regimen, its compliance by the patient and monitoring of possible side effects.

Disease monitoring

Tuberculosis monitoring includes several key stages:

• Control stages: regular examinations of the patient, control of mycobacteria in sputum, X-ray examinations every 2-3 months.
• Prognosis: depends on the form of the disease, the state of the patient’s immune system and his/her commitment to therapy.
• Complications: possible relapses, development of resistant forms, irreversible changes in lung tissue.

Good monitoring allows timely measures to be taken to prevent severe forms of the disease and its consequences.

Age-related features of the disease

Tuberculosis can manifest itself differently depending on the age group:

• Children: In children, the infection often manifests itself in a more aggressive form, with a high tendency for the process to generalize, which requires careful monitoring and early diagnosis.
• Adults: Chronic forms of tuberculosis are more common in older adults, which can lead to a protracted course of the disease and more pronounced symptoms.
• Older adults: In older adults, the disease may be less noticeable due to a decreased immune response, but its consequences may be more severe.

This division into age groups facilitates a more targeted approach to prevention and treatment.

Questions and Answers

• What is pulmonary tuberculosis?
  Pulmonary tuberculosis is an infectious disease caused by mycobacteria, most commonly Mycobacterium tuberculosis, which primarily affects the lungs, causing chronic inflammation and tissue necrosis.
• How is tuberculosis transmitted?
  Tuberculosis is spread through the air. The infection can be spread by coughing, sneezing, or talking to someone with tuberculosis.
• What are the symptoms of tuberculosis?
  The main symptoms of tuberculosis include persistent cough, weight loss, night sweats, fever and weakness. As the disease progresses, hemoptysis and shortness of breath may also occur.
• How long does tuberculosis treatment last?
  Treatment for tuberculosis usually lasts from 6 to 12 months, depending on the form of the disease and the severity of the patient's condition. Regular monitoring and adherence to the treatment regimen are critical to prevent relapses.
• How can tuberculosis be prevented?
  Prevention of tuberculosis includes immunization (BCG vaccine), improvement of living conditions, early diagnosis and treatment of infected persons, and education of the population about risk factors and modes of transmission of infection.