Pulmonary Tuberculosis

Tuberculosis infection is an important issue for human health, the quality continues. Health education, some shortcomings in management, socio-economic conditions and other factors, prevention and treatment of tuberculosis disease in Turkey could not be achieved the necessary success.

Pathogenesis and pathology

Mycobacterium tuberculosis Disease "mycobacterium tüberkülosis" husule with income. Patients with active tuberculosis coughs, sneezes, or even of speech and song söylemesiyle droplets inhaled by others leads to the spread of infection. Tuberculosis infection is easily passed from items. Patients were not to infect others for the coughing and sneezing and mouth with a tissue paper burunlaranı örtmeli for example, the toilet must take place and these wipes will not harm anyone. Used by patients, plates, cutlery items such as washing cleanly usually provides adequate protection.

Most importantly, patients with the disease early and effective treatment for bulaşmaması others. Thus, the nature of bulaştıncı tuberculosis in patients lose a week's time. However, this time winning cases, and adequate resistance to drugs, disease and untreated ages longer.

Droplets when they are inhaled broncho days for Mycobacterium tuberculosis alveoli begin to multiply, spread to regional lymph nodes and sometimes to other organs through the bloodstream. Pulmonary tuberculosis due to aerobic conditions most conducive to the development of basillerinin organ growth and infection. 6-8 weeks after the contamination of a specific cellular immunity and prevented from multiplying bacilli developed. But at least a portion of those infected, approximately 5%, not developed enough defense consists of tuberculosis disease.

Pathogenesis and immunology of tuberculosis in recent years started to be understood better. Mikobakteriyle infected droplets (coughing, sneezing, singing, speaking, and are formed) are in contact makrofajlarla alveoldeki ago, the proliferation of these macrophages phagocytosed bacilli, stopping and heal disease. Phagocytosis of polymorphonuclear leukocytes is an important core is located. If the quality is not sufficient phagocytosis bacilli multiply, devastated by macrophages other macrophages, lungs and spread to lymph nodes. Tuberculosis consists of a pneumonia. Basilleriyle tuberculosis antigens of macrophages in contact with the T4 (helper), T8 (suppressor) lymphocytes and B cells and thus stimulate the cell tissue through the lesion area to come to a developing immune, COMM (CMI-cell mediated immunity) and delayed-type hypersensitivity VTS (DTH-delayed type hypersensitivity) occurs. HAB and the GTH icon niteliğindedir immunity in tuberculosis. These lymphocytes cause the decline and loss. T lymphocytes develop interleukin I, interleukin II, and gamma interferon, transfer factor immunomodulatory niteliğindedir, immunity to improve the infection developed olurlar.Tüberküloz immünog-lobülinler (Ig G, Ig A, Ig M) and DNA, ELISA (enzyme linked immunoassay) and RIAS ( radioimmuno assay) methods and the activity of the early period following the early diagnosis of tuberculosis is understandable.

There are three main defense mechanism and disease Tuberculosis basilleriyle: 1 Mechanical and physical activity-especially in the upper respiratory tract of a purification mükosilyer. 2. Macrophages and polymorphonuclear leuko-core-sites in particular, the activity of phagocytes. And 3 COMM and acquired immunity developed by VTS. The acquired immune süperimposedir natural immunity, the effect of each other's promoters.

Personal immunity in the occurrence of infection, bacterial virulence and the number of cigarettes, alcohol, diabetes, cancer, Hodgkin's disease, an important facilitator of steroid drugs, such as immunogenicity-nosüpresif factors.

Primary tuberculosis

For the first time in a person infected with TB disease develops it the "primary tuberculosis primary complex''or''is called. This type of tuberculosis usually develops in the lower lobes. It has two components:

1. Parenkimasında pneumonic infiltration in the developing lung. 2. Hilar adenopathy of the lymph gland infection spread across this lesion. The first infection kazeif ikasyon necrosis, granuloma and Langhans giant cells composed of the typical pathological changes. Granuloma fibrosis and calcification are tracked over time to heal. Primary tuberculosis in the lung lesion was calcified calcified ipsilateral hilar lymph node is called Ghon complex. Ghon complex than once localized to the lower lobes. Caseation necrosis and infiltration occurred at the location of tuberculosis in adults with primary tuberculosis infection even though there is such a development. However, in some cases, infiltration of primary tuberculosis in caseation necrosis-Intracavernous may be developed. The primary clinical manifestations of tuberculosis often unimportant, or are not qualities suggestive of a tuberculosis infection. Therefore, the diagnosis of primary tuberculosis without too many times overlooked.
Primary tuberculosis in children than adults are often observed. Income and a calcification in the majority of cases of spontaneous recovery husule remains.

Milyer tuberculosis infection spread through the bloodstream without the immune scheme well, such as meningitis, tuberculosis and other serious diseases can cause organ tüberkülozlarına. The primary cause of tuberculosis pleurisy pleural spread. In some cases of primary tuberculosis is adenopathy, adenopathy alone has seen some of the radiograph parenchymal lesions.

Pleural fluid (pleurisy) is easy to diagnose tuberculosis is due cause, and sometimes difficulties are encountered. Young in a patient with tuberculosis pleurisy, while those age 40-50, more than cancer or heart failure think. However, a significant increase in tuberculosis in Turkey in recent years because of pleurisy is common in middle and older ages in the türberküloz origin. For definitive diagnosis based on puncture of the pleural fluid cytological, bacteriological, and now I shall review.

Postprimer-re-infection tuberculosis

Undergoing primary tuberculosis, then the young people and adults and Intracavernous with caseation necrosis-a characteristic of tuberculosis can occur, also called "adult tuberculosis" or "re-infection tuberculosis is called.

There are four main distinctive feature of tuberculosis primary tuberculosis in adults:
1. Tuberculosis in adults is usually a reenfeksiyondur endogenous, that is, primary tuberculosis lesions from husule previously hidden, dormant nature of the disease, the bacteria multiply and form of tuberculosis. 2. Most upper lobe and lower lobe superior segments-Larda is localized. 3. Necrosis-kazeifikasyonla kavernleşme monitored. 4. Hilar adenopathy is a rare finding in tuberculosis re-infection followed.

But both need to re-infection tuberculosis primary tuberculosis always the typical clinical and radiological aspects of the nature of the seen and the diagnosis is similar to other diseases can cause difficulties.

Clinical symptoms

There is a significant number of patients in clinical signs or hard to overlook nature. The main symptoms of the disease, fatigue, loss of appetite, explanation power weight loss, fever and night sübfebril smells his sweat. The general symptoms of systemic or local signs monitors. Their main cough, chest pain and hemoptysis. Dyspnea, or pleural fluid at a time when the disease is so common with many of the tuberculosis or another disease is monitored is located. Initially dry cough, sputum, and then later a purulent sputum mucus occur together. Pleurisy without chest pain is not normal, but in some cases, blunt, stinging a strain sensitivity of a chest pain or chest occurs. Approximately 10% of TB patients is an important symptom for the diagnosis of the disease hemop-treble. This alarm is also called hemoptysis.

Physical examination

Primary tuberculosis cases are not usually an abnormal finding. Severe and widespread lesions in the patients followed a general affection, there are pale and look grumpy. Decreased elasticity of the skin. The lesion may be wider local crepitan Railer. Sometimes the pressure of bronşa sibilan ganglia and causes ronflan Railer.

Re-infection tuberculosis examination of early or small lesions are not an oddity or a light percussion, auscultation, and perhaps a change is monitored Railer crepitan marked deformity. This Railer duyulurlar better after coughing. Segment sübmatite or dullness or lobar lesions can be, for example, bronkovesiküler altered breath sounds, bronchial breathing, sibilan, ronflan Railer heard. Eskiliğine of the disease and the prevalence varies according to the findings. Chronic fibrosis in lesions caused by movements of the chest in the form of the old and bring husule asymmetry, changes in the mediastinum and trachea. Thoracic muscle atrophy, venous circulation because of complete or partial obstruction of the superficial venous dilatation can be seen in the chest. Sympathetic nerve lesions can print or destruction. Paralizinde phrenic nerve diaphragm lift up the chest, such as the base of the inspection there was evidence of fluid is taken. Localized to the periphery and the open drainage bronchus kavernlerde "Kave murmur", crepitan Railer heard. However, an abnormal drainage bronchus kavernlerde sound will not be closed. Chronic lung tübertkülozunda sibilan, ronflan Railer, expiratory prolongation, decreased breath sounds, and certain lung harabiyetiyle the development of emphysema may be related to a secondary. Pneumothorax, pleurisy, or if you have chest pain increased respiration, such as dullness or hipersonorite findings are observed.
Apart from other organs such as the respiratory system, kidneys, spine, lymph nodes, joints, skin, liver and spleen, organs with the possibility of settlement, such as tuberculosis should be examined. Is localized to the prostate and epididymis tuberculosis genital organs in men. Popular fliktenüler konjontivi-tis should be investigated. Tuberculous meningitis sertlliği neck, eye paralysis, can be found Kernig sign. Chronic tüberkülozlarda Comag change drum fingers may develop. Indicated for bronchial cancer in a short period of time is more developed clubbing.

Radiological findings

Primary tuberculosis lower lobe parenchymal infiltration, adenopathy, or pleural effusion can be seen paratrakeada or hilum.

Infiltration in the posterior segments of upper lobe tuberculosis re-infection, many times Intracavernous monitored. These lesions are unilateral or bilateral. Tüberkülozlarda AIDS related illness, many times without the lower lobe of the Intracavernous infiltration, hilar adenopathy, and pleural effusion are. AIDS is usually an endogenous reactivation of tuberculosis as a result viewed husule income.

Lower lobe basal segments more diabetics re-infection tuberculosis, is seen in women and blacks. X-ray diagnosis of pulmonary tuberculosis re-infection seen in the changes to the following important findings helpful:

1. Lesions in the upper lobes
2. İntizamsız or nodular lesions
3. Intracavernous or kavernlerin there (the modifications abscess, cancer and other diseases can be found)
4. Calcification present
5. Bilateral lesions, especially in those parts of the upper lung
6. Films taken in a few weeks after the persistence of the lesion. View radiographic changes of pneumonia and other lung infections. However, as soon as possible improving or worsening pulmonary tuberculosis can be deceiving in this regard.

The radiological appearance of tuberculosis re-infection is very important in terms of diagnosis, although born in the diagnosis of bacteriological and other examinations-rulanmalıdır. Bacterial pneumonia, viral pneumonia, pulmonary fibrosis, bronchiectasis, lung cancer, thrombo-embolism, silicosis, tuberculosis may resemble sarkoidosis and radiological appearance of diseases such as histoplasmosis. Should be considered in the differential diagnosis of this disease.


Examination of sputum

Tuberculosis bacilli in sputum or other material for definitive diagnosis of tuberculosis need to find out. Direct examination is less than bacilli may not be seen, culture is produced by bacilli. Direct examination of the culture of the bacillus should be positive. Thus, the definite diagnosis, drug sensitivity or resistance to antituberculosis hemde cultured bacilli investigated. Drug resistance has been increasing and 30-some countries up to 50% increases.

Tuberculosis factor "mycobacterium tüberkülosis" in recognition of that makes it resistant to acid. Mycobacterium tuberculosis Ziehl-Neelsen staining method most used.

Before starting treatment at the three morning sputum to be sent to be examined. Bacilli in the sputum is more convenient in terms of the first morning there. Ziehl-Neelsen staining of sputum and other examined enough material for a lama from the patient thoroughly after spreading, and the smoke will be placed on the abundance of carbon-fuchsine heated for 3 minutes. After this is washed with water and acid-alcohol mixture is washed up with the red color gelmeyinceye. Methylene blue or brilliant green dye is exposed to 30 seconds. Again washed and dried. Microscope-positive bacilli seen, seen is interpreted as negative. Each slide down to be able to say at least 5 minutes, preferably 10-15 minutes, should be examined.

Homojenizasyonla bacilli bacillus is not found within or between direct procedure by reducing the volume of the material is increased by the chance to see. Furthermore, in terms of each sputum culture for Mycobacterium tuberculosis should be made. Culture 3 aim to:

1. And therefore can not be found in a small amount of direct and homojenizasyonla multiplying bacilli seen increases chances.
2. Recognition of Mycobacterium tuberculosis is provided another other mycobacteria.
3. Beef is produced on-site drug sensitivity and resistance of bacilli investigated.
Koch's bacillus growth medium for the production of the most commonly used Lowenstein-Jensen culture. There are plenty of eggs and potatoes. Bacilli growth is slow, 2-8 weeks (average 6 weeks) is required.
Patient adequate sputum or ultrasonic aerosol inhalation of hypertonic saline çıkaramıyorsa water droplets created wares inhalasyonuyla söktürülür sputum.

Bacilli in sputum aspiration in patients who can not stomach the water is another method for the examination. Are in hospital. A catheter inserted into her stomach that night before getting up for morning sick stomach is aspirated material was collected and cultured bronchial sown. Taken by bronchoscopy in patients with sputum production is an important method of bacteriological and cytological lavage or biopsy to investigate materyelinin.

For example if you have suspicion of pulmonary tuberculosis in an organ outside the pleural fluid, cerebrospinal fluid, urine or joint fluid are analyzed for Mycobacterium tuberculosis. If necessary, the peripheral lymph adenopathy (cervical lymph node, for example), lung, pleura, liver and bone marrow biopsies histo-pathological examination of the similar clinical and radiological findings can be helpful in the diagnosis of certain diseases such as tuberculosis and cancer. Drug sensitivity of Koch bacillus to know the culture of this biopsy examination should not neglect.

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