Atypical Pulmonary Tuberculosis
Soil, water, milk and some acid-resistant bacteria in animals as a saprophyte in the clinical and radiological causes a disease similar to tuberculosis. These "opportunistic mycobacteria," or "nontüberküloz mycobacteria are known as". Clinical and radiological approximately 5% of cases of atypical tuberculosis diagnosed with tuberculosis.
4 The main group of atypical mycobacteria:
Group I. Fotokromojenler (M.kansasii, M. luciflavum)
Group II. Skotokromojenler (M.skrofulaseum)
Group III. Nonkromojenler (M.intrasellulare or Battey bacillus, M.avium, M.xenopi)
Group IV. Feeding-site fast bacilli isolated (M.bakterium fortiutum)
Quick isolated mycobacteria grow rapidly in soil M.fortiutum 25 degrees, can cause lung disease in humans.
The most important complication of tuberculosis disease M.avium intrasellulare AIDS.
Chronic obstructive pulmonary disease, pneumoconiosis, tuberculosis, bronchiectasis, chronic lung disease such as atypical tuberculosis infections are monitored more frequently. And many middle-aged or elderly patients with atypical mycobacteria lung of men.
Clinical and Radiological Findings
Clinical symptoms are the same as pulmonary tuberculosis, but not acute, severe pulmonary tuberculosis are rare findings are followed up.
Atypical mycobacteria are difficult to diagnose the disease. Sputum, lymph node biopsy or resection material to provide a definitive diagnosis idantifîkasyonuyla related bacteria. Tuberculin test was positive or negative light.
Treatment and Prognosis
Asimptomatik cases or cases of non-specific treatment progress is needed. The current run with the control of chronic disease. The disease is progressive in the specific treatment. AIDS infection in patients with lung diseases such as pneumoconiosis and those with less than the success of treatment. Atypical mycobacteria resistant to most tuberculosis drugs.
The results of in vitro resistance and treatment success in tuberculosis, as well as a close relationship between the no. However, despite the results of resistance to drug treatment if the treatment is applied.
Showing posts with label Pulmonary and Non Pulmonary Tuberculosis Diseases. Show all posts
Showing posts with label Pulmonary and Non Pulmonary Tuberculosis Diseases. Show all posts
Tuberculous Pericarditis
Tuberculous pericarditis
Approximately 20% of all cases of tuberculosis pericarditis nature. Tuberculosis pericarditis spread of tuberculosis in the neighboring regions husule perikarda income. The disease begins with inflammation fibrinous or serofibrinöz talented. There is usually a liquid perikard'da. Can be found in the pericardium and pleural effusion. Tuberculosis rarely reaches perikarda lenfojen or hematogenously.
Retrosternal dullness physical examination, heart sounds heard with difficulty, pericardium frotmanı, paradoxical pulse, and the left lung base of the paravertebral is dullness.
Chest radiography, tuberculin test and the diagnosis is supported by ECG. Radiography enlarged heart is the limit. This expansion is similar to the growth of the heart, sometimes difficult to distinguish between the two. Chest radiography, pulmonary tuberculosis, or whether the pleural fluid should be examined. Standard electrocardiographic leads in the first period of the disease seen in ST-elevation-Larda, ST segments return to normal after a few days. Taken by puncture of the pericardial fluid, Simi, bacteriological and cytological examined.
Perikarditten Serofibrinöz tuberculosis a few years or in some cases after a long period of chronic constrictive pericarditis is husule.
The main clinical symptoms of chronic perikardit'nin paradoxical pulse and heart towards the obstruction of venous circulation. The main symptoms of obstruction, hepatomegaly, peripheral edema, increased venous pressure and acid.
Radiological examination of the heart is small and the movements are reduced.
Pericarditis is a serious disease of tuberculosis. Antituberculosis drugs and steroids, as is done in tuberculosis treatment milyer. Antituberculosis drug therapy for at least two years.
Approximately 20% of all cases of tuberculosis pericarditis nature. Tuberculosis pericarditis spread of tuberculosis in the neighboring regions husule perikarda income. The disease begins with inflammation fibrinous or serofibrinöz talented. There is usually a liquid perikard'da. Can be found in the pericardium and pleural effusion. Tuberculosis rarely reaches perikarda lenfojen or hematogenously.
Retrosternal dullness physical examination, heart sounds heard with difficulty, pericardium frotmanı, paradoxical pulse, and the left lung base of the paravertebral is dullness.
Chest radiography, tuberculin test and the diagnosis is supported by ECG. Radiography enlarged heart is the limit. This expansion is similar to the growth of the heart, sometimes difficult to distinguish between the two. Chest radiography, pulmonary tuberculosis, or whether the pleural fluid should be examined. Standard electrocardiographic leads in the first period of the disease seen in ST-elevation-Larda, ST segments return to normal after a few days. Taken by puncture of the pericardial fluid, Simi, bacteriological and cytological examined.
Perikarditten Serofibrinöz tuberculosis a few years or in some cases after a long period of chronic constrictive pericarditis is husule.
The main clinical symptoms of chronic perikardit'nin paradoxical pulse and heart towards the obstruction of venous circulation. The main symptoms of obstruction, hepatomegaly, peripheral edema, increased venous pressure and acid.
Radiological examination of the heart is small and the movements are reduced.
Pericarditis is a serious disease of tuberculosis. Antituberculosis drugs and steroids, as is done in tuberculosis treatment milyer. Antituberculosis drug therapy for at least two years.
Tuberculosis Meningitis
Non-Tuberculosis Lung
Serosa tuberculosis (pleural, meningitis, pericardium and peritoneum), larynx and larynx tuberculosis neighboring organs, the trachea-bronchial tuberculosis, gastrointestinal tuberculosis, tuberculosis of the lymph system, liver and spleen, tuberculosis, urogenital tuberculosis, ocular tuberculosis and extrapulmonary tuberculosis are major adrenal tuberculosis. Extrapulmonary tuberculosis pleural diseases pleural tuberculosis has an important place in the group was written.
Tuberculosis Meningitis
Milyer is an important complication of tuberculosis. Hematogenous spread of tuberculosis in central nervous system husule infek-siyonunun income. It is not necessary for the development of tuberculosis meningitis milyer presence of tuberculosis. Worse prognosis than is found with the two diseases.
Insidious onset of tuberculosis meningitis. Clinical symptoms gradually improved. Headache, fever, irritability, fatigue, weight loss and vomiting, the main symptoms of the disease. Later, disturbances of consciousness, strabizm, photophobia, ocular paralysis and limb paralysis husule income. Babinski reflex is positive. Feeling of suffocation, coma and epistotonus later symptoms of the disease. Neck stiffness is often an early symptom often found in conjunction with increased reflexes and signs of Kernig and Brudzinsky. Kernig signs of neck, back and waist, and these regions bükülmeğe resistant hardness. Brudzinsky symptoms are related to irritation of the meninges are neck and legs, stiffness, resist twisting.
Fuzzy spider web like appearance of cerebrospinal fluid, fluid pressure increases, increase in leukocyte (particularly an increase in lymphocytes), an increase in protein, sugar and most important findings for the diagnosis of tuberculous meningitis reduced chloride
Is 100% of untreated cases, death. An appropriate treatment of cases in more than 80% improvement in revenue husule. Early initiation of treatment increases the chance of success. Treatment should continue for 2-3 years. Recovering approximately 10% of the cases accepted neurological abnormalities. Isoniazid, rifampin, ethambutol, streptomycin, and start with the quadruple drug therapy. Beginning of the treatment of corticosteroid used. Lasted for 2-4 weeks after the acute phase (disappearance of clinical symptoms) by reducing the steroids gradually cut off. Antituberculosis drugs and doses milyer kortikosteroid'in is written about tuberculosis.
Serosa tuberculosis (pleural, meningitis, pericardium and peritoneum), larynx and larynx tuberculosis neighboring organs, the trachea-bronchial tuberculosis, gastrointestinal tuberculosis, tuberculosis of the lymph system, liver and spleen, tuberculosis, urogenital tuberculosis, ocular tuberculosis and extrapulmonary tuberculosis are major adrenal tuberculosis. Extrapulmonary tuberculosis pleural diseases pleural tuberculosis has an important place in the group was written.
Tuberculosis Meningitis
Milyer is an important complication of tuberculosis. Hematogenous spread of tuberculosis in central nervous system husule infek-siyonunun income. It is not necessary for the development of tuberculosis meningitis milyer presence of tuberculosis. Worse prognosis than is found with the two diseases.
Insidious onset of tuberculosis meningitis. Clinical symptoms gradually improved. Headache, fever, irritability, fatigue, weight loss and vomiting, the main symptoms of the disease. Later, disturbances of consciousness, strabizm, photophobia, ocular paralysis and limb paralysis husule income. Babinski reflex is positive. Feeling of suffocation, coma and epistotonus later symptoms of the disease. Neck stiffness is often an early symptom often found in conjunction with increased reflexes and signs of Kernig and Brudzinsky. Kernig signs of neck, back and waist, and these regions bükülmeğe resistant hardness. Brudzinsky symptoms are related to irritation of the meninges are neck and legs, stiffness, resist twisting.
Fuzzy spider web like appearance of cerebrospinal fluid, fluid pressure increases, increase in leukocyte (particularly an increase in lymphocytes), an increase in protein, sugar and most important findings for the diagnosis of tuberculous meningitis reduced chloride
Is 100% of untreated cases, death. An appropriate treatment of cases in more than 80% improvement in revenue husule. Early initiation of treatment increases the chance of success. Treatment should continue for 2-3 years. Recovering approximately 10% of the cases accepted neurological abnormalities. Isoniazid, rifampin, ethambutol, streptomycin, and start with the quadruple drug therapy. Beginning of the treatment of corticosteroid used. Lasted for 2-4 weeks after the acute phase (disappearance of clinical symptoms) by reducing the steroids gradually cut off. Antituberculosis drugs and doses milyer kortikosteroid'in is written about tuberculosis.
Tuberculosis Milyer
Milyer Tuberculosis, Tuberculosis Milyer
Milyer untreated tuberculosis is a serious and fatal disease. Milyer tuberculosis patients should be hospitalized for treatment. Antituberculosis drug treatment of patients with tuberculosis in the milyer are approximately 20% of deaths. The rate of tuberculosis infection in a serious show that the extent of the disease. The death rate in patients with tuberculosis meningitis milyer is more.
Pathogenesis and pathology
Milyer hematogenous tuberculosis during primary infection in young children more with a spread of income husule. Furthermore, the hematogenous spread postprimer tüberkülozlardan milyer tuberculosis may develop as a result. Tuberculosis, measles and whooping cough milyer facilitate infections.
2-3 mm in diameter Milyer millet tuberculosis cases (Milet) consists of the size of lesions. Miletus was the word name of the disease. The main elements of the lesions Milyer epithelioid cells, lymphocytes and giant cells of Lang-hans. Other organs, especially the liver, spleen and kidneys milyer husule spread income. Pleurisy, meningitis, peritonitis and pericarditis with such deployments (poliserositis) is followed quite often. Some milyer tuberculosis cases decreased infection resistance is an important way. For this reason, tuberculin skin test is negative or uncertain nature. Antituberculosis drug therapy developed active immunity scheme is a positive tuberculin reaction.
Clinical symptoms
% Of tuberculous meningitis in tuberculosis disease has Milyer 30'nda and related symptoms of the disease help diagnose tuberculosis in olur.Milyer main symptom of fever. Initially, there is a slight cough, the disease progresses, becomes more prominent and ever-increasing dyspnea and syanoz husule income. Infectious fever does not show a specific feature. Fire intizamsız, uniform, high or floating may be higher. Patients have a marked tachycardia and tachypnea. Tachypnea is usually proportional to the fire nature.
There are certain abnormalities in the lungs of a physical examination. Advanced stages of the disease may be common fine Railer. Splenomegaly and hepatomegaly in approximately half of the cases are more rare. Whereas a pathognomonic finding is important and examination of the eye tubercle koriodia'da, half of the cases monitored.
Radiological findings
Milyer chest radiography in the diagnosis of tuberculosis is an overview of the most important. Scattered equally in all directions in the lungs as small pinhead sized millet or micronodular lesions are seen. The disease came together to proceed in this small lesions look tipisi husule snow comes. In some cases the primary radiograph or a tuberculosis postprimer visible lesions and pleurisy.
Diagnosis and treatment
The most important finding milyer radiographic changes. Koch's bacillus in sputum and gastric juice antituberculosis drugs, sensitivity must be sought and examined. In the cases of tuberculous meningitis with Milyer se-robrospinal fluid analysis is useful in diagnosis. Furthermore, bone marrow, urine, pleural and joint fluid of Koch's bacillus should be sought direct and culture methods. Autopsy studies in 100% of cases of tuberculosis milyer lung, liver, tuberculous lesions seen in 90% of lung and liver biopsies are used for diagnosis when needed.
If you wait for the outcome of suspected tuberculosis and tuberculin Milyer bacteriology should begin treatment. Isoniazid, rifampin, ethambutol stereptomisin medications and treatment of four starts. For example, isoniazid 10-20 mg / kg, rifampin, 10-20 mg / kg and streptomycin 20 mg / kg and ethambutol 25 mg / kg doses given. After a period of acute disease (4-6 weeks), double or triple drug therapy is completed in 2 years. 7-14 days at the beginning of the disease is 30-40 mg / day corticosteroids-thyroid is used. After this time, by reducing the daily dose of 2 mg of steroid treatment is concluded.
Milyer untreated tuberculosis is a serious and fatal disease. Milyer tuberculosis patients should be hospitalized for treatment. Antituberculosis drug treatment of patients with tuberculosis in the milyer are approximately 20% of deaths. The rate of tuberculosis infection in a serious show that the extent of the disease. The death rate in patients with tuberculosis meningitis milyer is more.
Pathogenesis and pathology
Milyer hematogenous tuberculosis during primary infection in young children more with a spread of income husule. Furthermore, the hematogenous spread postprimer tüberkülozlardan milyer tuberculosis may develop as a result. Tuberculosis, measles and whooping cough milyer facilitate infections.
2-3 mm in diameter Milyer millet tuberculosis cases (Milet) consists of the size of lesions. Miletus was the word name of the disease. The main elements of the lesions Milyer epithelioid cells, lymphocytes and giant cells of Lang-hans. Other organs, especially the liver, spleen and kidneys milyer husule spread income. Pleurisy, meningitis, peritonitis and pericarditis with such deployments (poliserositis) is followed quite often. Some milyer tuberculosis cases decreased infection resistance is an important way. For this reason, tuberculin skin test is negative or uncertain nature. Antituberculosis drug therapy developed active immunity scheme is a positive tuberculin reaction.
Clinical symptoms
% Of tuberculous meningitis in tuberculosis disease has Milyer 30'nda and related symptoms of the disease help diagnose tuberculosis in olur.Milyer main symptom of fever. Initially, there is a slight cough, the disease progresses, becomes more prominent and ever-increasing dyspnea and syanoz husule income. Infectious fever does not show a specific feature. Fire intizamsız, uniform, high or floating may be higher. Patients have a marked tachycardia and tachypnea. Tachypnea is usually proportional to the fire nature.
There are certain abnormalities in the lungs of a physical examination. Advanced stages of the disease may be common fine Railer. Splenomegaly and hepatomegaly in approximately half of the cases are more rare. Whereas a pathognomonic finding is important and examination of the eye tubercle koriodia'da, half of the cases monitored.
Radiological findings
Milyer chest radiography in the diagnosis of tuberculosis is an overview of the most important. Scattered equally in all directions in the lungs as small pinhead sized millet or micronodular lesions are seen. The disease came together to proceed in this small lesions look tipisi husule snow comes. In some cases the primary radiograph or a tuberculosis postprimer visible lesions and pleurisy.
Diagnosis and treatment
The most important finding milyer radiographic changes. Koch's bacillus in sputum and gastric juice antituberculosis drugs, sensitivity must be sought and examined. In the cases of tuberculous meningitis with Milyer se-robrospinal fluid analysis is useful in diagnosis. Furthermore, bone marrow, urine, pleural and joint fluid of Koch's bacillus should be sought direct and culture methods. Autopsy studies in 100% of cases of tuberculosis milyer lung, liver, tuberculous lesions seen in 90% of lung and liver biopsies are used for diagnosis when needed.
If you wait for the outcome of suspected tuberculosis and tuberculin Milyer bacteriology should begin treatment. Isoniazid, rifampin, ethambutol stereptomisin medications and treatment of four starts. For example, isoniazid 10-20 mg / kg, rifampin, 10-20 mg / kg and streptomycin 20 mg / kg and ethambutol 25 mg / kg doses given. After a period of acute disease (4-6 weeks), double or triple drug therapy is completed in 2 years. 7-14 days at the beginning of the disease is 30-40 mg / day corticosteroids-thyroid is used. After this time, by reducing the daily dose of 2 mg of steroid treatment is concluded.
Conditions Affecting the treatment of tuberculosis
Conditions Affecting the treatment of tuberculosis
No matter what month of pregnancy Pregnancy diagnosis of tuberculosis treatment should start edilince. Etyonamid and injectable drugs (streptomycin, and kanamycin kapreomisin) fetüs'e can be toxic.
Kidney failure possible, nephrotoxic side effects in patients with kidney disease with streptomycin, kanamycin, kapreomisin, ethambutol, and cycloserine kullanümamaldır. Patient with drug-resistant bacilli or other toxic drugs, a situation that if you have written above, by controlling renal function may be nephrotoxic drugs.
SGOT and SGPT are reviewed prior to the treatment of liver disease. Much impressed by the selection of mild disorder drug. SGOT or SGPT increases 3-4 times hepatotkosik drugs (isoniazid, rifampin, pyrazinamide) are the side effects of treatment programs to be evaluated. The first 1-2 weeks of treatment and 3-4 weeks later SGOT, SGPT examined.
Tuberculosis morbidity and mortality is higher in patients with diabetes mellitus. There are some features with the cases of diabetes and tuberculosis. Therefore, all cases of chronic tuberculosis and diabetes cases investigated do not respond well to treatment, fasting blood sugar yetinmemeli being a normal, glucose tolerance test also assessed whether diabetes.
Tuberculosis - the normal daily calories is sugar patient, ie, diabetes, glycemic diet and oral antidiabetic drugs or insulin to be controlled. Blood sugar should be checked frequently during the treatment period. Tüberkolüz drug therapy is successful, many times the need for oral antidiabetic drugs and insulin is reduced. This observation is a good index showing that effective treatment of tuberculosis. If the tuberculosis drug therapy is not effective in controlling blood sugar can not be easy. Oral antidiabetic drugs and insulin must be increased. Sugar-tuberculosis patients, the start of treatment in the morning and afternoon blood sugar is checked twice a day or night, and if necessary, antidiabetic drugs, eg insulin twice a day are complying with these findings. Antituberculosis drugs in patients with diabetes-tuberculosis will continue for 12 months or longer if necessary.
Prenvantif drug therapy
Risk of TB than in those with isoniazid and rifampin used in conjunction with preventive purpose. In adults, a daily dose of isoniazid and rifampin 300 mg daily dose is 600 mg. These drugs are given one or two installments if necessary. Treatment duration is one year. Preventive drug therapy of primary tuberculosis meningitis, bone or kidney, such as extrapulmonary tuberculosis, 85% are effective in preventing complications yonlarını. Koch's bacillus in adults with the theme of preventive treatment with 80% effective.
Surgical Treatment
Tuberculosis infection is treated with drugs. Cases, surgical treatment is not responding to drug treatment. The main indications for surgical treatment:
1. 3-6 months after initiation of drug treatment, even Koch bacilli in sputum-positive cases have to be open and Intracavernous or kavernlerin. The first is used when isoniazid, rifampin, streptomycin, pyrazinamide and ethambutol-resistant bacilli, such as drugs, have 2 or more indications for surgery reinforces.
2. Sputum cultures remain positive despite the necessary medical treatment and lost the functional nature of a lung lobe or an entire regional bron-şektazi, causing changes in secondary atelectasis or obstructive inflammation of bronchial stenosis and caseous nodules require extensive surgery pathological finding the remains. Intracavernous absence does not preclude surgical intervention. Lesions of specific and non-specific treatment, improve, inter-mitan infections or recurrent or persistent bronchial and parenchymal he-moptizilere involves the surgical intervention, even when applied to negative bacilli.
3. Medical treatment of tuberculosis bronkoplöral fistula is not close.
4. Empyema unresponsive to medical treatment.
5. Open-healed (open-negative bacilli) Intracavernous. This topic is controversial. The standard treatment is fully implemented, the control is good and the possibilities of reactivation tuberculosis in the absence of disease or socio-eco-nomic conditions that require the best surgical intervention in cases not be left open Intracavernous-negative bacilli.
6. Diameter of nodular or cavitary lesions 1.5-3.0 part there has not been as definitive etiology, these lesions is surgical intervention.
Are two main types of surgical intervention in pulmonary tuberculosis:
1. Lobectomy and 2 Pneumonectomy
Recurrent pneumothorax, empyema did not respond to medical treatment in cases of pleural thickening and lung function affecting the intensive and extensive decortication (resection of parietal pleura) is applied.
A serious disease, respiratory failure, bilateral and diffuse lung disease, severe systemic disease, for example, serious kidney, liver, and surgical intervention in patients with blood disease kontredikedir. Generally, surgical intervention during pregnancy is not applicable. On tuberculosis drug therapy is necessary until the end. However, this treatment does not result in a desired surgical procedure can be applied.
No matter what month of pregnancy Pregnancy diagnosis of tuberculosis treatment should start edilince. Etyonamid and injectable drugs (streptomycin, and kanamycin kapreomisin) fetüs'e can be toxic.
Kidney failure possible, nephrotoxic side effects in patients with kidney disease with streptomycin, kanamycin, kapreomisin, ethambutol, and cycloserine kullanümamaldır. Patient with drug-resistant bacilli or other toxic drugs, a situation that if you have written above, by controlling renal function may be nephrotoxic drugs.
SGOT and SGPT are reviewed prior to the treatment of liver disease. Much impressed by the selection of mild disorder drug. SGOT or SGPT increases 3-4 times hepatotkosik drugs (isoniazid, rifampin, pyrazinamide) are the side effects of treatment programs to be evaluated. The first 1-2 weeks of treatment and 3-4 weeks later SGOT, SGPT examined.
Tuberculosis morbidity and mortality is higher in patients with diabetes mellitus. There are some features with the cases of diabetes and tuberculosis. Therefore, all cases of chronic tuberculosis and diabetes cases investigated do not respond well to treatment, fasting blood sugar yetinmemeli being a normal, glucose tolerance test also assessed whether diabetes.
Tuberculosis - the normal daily calories is sugar patient, ie, diabetes, glycemic diet and oral antidiabetic drugs or insulin to be controlled. Blood sugar should be checked frequently during the treatment period. Tüberkolüz drug therapy is successful, many times the need for oral antidiabetic drugs and insulin is reduced. This observation is a good index showing that effective treatment of tuberculosis. If the tuberculosis drug therapy is not effective in controlling blood sugar can not be easy. Oral antidiabetic drugs and insulin must be increased. Sugar-tuberculosis patients, the start of treatment in the morning and afternoon blood sugar is checked twice a day or night, and if necessary, antidiabetic drugs, eg insulin twice a day are complying with these findings. Antituberculosis drugs in patients with diabetes-tuberculosis will continue for 12 months or longer if necessary.
Prenvantif drug therapy
Risk of TB than in those with isoniazid and rifampin used in conjunction with preventive purpose. In adults, a daily dose of isoniazid and rifampin 300 mg daily dose is 600 mg. These drugs are given one or two installments if necessary. Treatment duration is one year. Preventive drug therapy of primary tuberculosis meningitis, bone or kidney, such as extrapulmonary tuberculosis, 85% are effective in preventing complications yonlarını. Koch's bacillus in adults with the theme of preventive treatment with 80% effective.
Surgical Treatment
Tuberculosis infection is treated with drugs. Cases, surgical treatment is not responding to drug treatment. The main indications for surgical treatment:
1. 3-6 months after initiation of drug treatment, even Koch bacilli in sputum-positive cases have to be open and Intracavernous or kavernlerin. The first is used when isoniazid, rifampin, streptomycin, pyrazinamide and ethambutol-resistant bacilli, such as drugs, have 2 or more indications for surgery reinforces.
2. Sputum cultures remain positive despite the necessary medical treatment and lost the functional nature of a lung lobe or an entire regional bron-şektazi, causing changes in secondary atelectasis or obstructive inflammation of bronchial stenosis and caseous nodules require extensive surgery pathological finding the remains. Intracavernous absence does not preclude surgical intervention. Lesions of specific and non-specific treatment, improve, inter-mitan infections or recurrent or persistent bronchial and parenchymal he-moptizilere involves the surgical intervention, even when applied to negative bacilli.
3. Medical treatment of tuberculosis bronkoplöral fistula is not close.
4. Empyema unresponsive to medical treatment.
5. Open-healed (open-negative bacilli) Intracavernous. This topic is controversial. The standard treatment is fully implemented, the control is good and the possibilities of reactivation tuberculosis in the absence of disease or socio-eco-nomic conditions that require the best surgical intervention in cases not be left open Intracavernous-negative bacilli.
6. Diameter of nodular or cavitary lesions 1.5-3.0 part there has not been as definitive etiology, these lesions is surgical intervention.
Are two main types of surgical intervention in pulmonary tuberculosis:
1. Lobectomy and 2 Pneumonectomy
Recurrent pneumothorax, empyema did not respond to medical treatment in cases of pleural thickening and lung function affecting the intensive and extensive decortication (resection of parietal pleura) is applied.
A serious disease, respiratory failure, bilateral and diffuse lung disease, severe systemic disease, for example, serious kidney, liver, and surgical intervention in patients with blood disease kontredikedir. Generally, surgical intervention during pregnancy is not applicable. On tuberculosis drug therapy is necessary until the end. However, this treatment does not result in a desired surgical procedure can be applied.
BCG Vaccine
What is the BCG vaccine, BCG vaccine against the disease which apply?
BCG "Basil-Calmette-Guerin" stands for the words. BCG tuberculosis bacilli Calmette and Guerin called investigators bovinus type of feeding over the years from producing a bacillus that reduced their virulence. This is to prevent tuberculosis infection or infection with bacilli vaksinasyonu light passes. Mechanism of action similar to the flower vaccine: a non-virulence organism brought husule lesion subsequent virulent infection provides a protective effect. Useful in protecting against disease, mass BCG tuberculosis vaccine. In this regard, BCG has been a good result in Turkey.
0.1 BCG is injected into the lower deltoid region intradermik. 3-4 weeks after vaccination, a papule husule income, a few weeks later, the papule appears, and passes through a slight ulceration. Sometimes the adjacent lymph nodes may be a slight growth. After about 3 months from the BCG tuberculin test is positive. BCG on the location of secondary infection, abseleşme rarely, very rarely occurs in the local lupoid reaction. Rarely, erythema nodosum, and urticaria may husule. 2% of all complications, the ratio of the uncertain nature and the vast majority of them.
Incidence of tuberculosis in countries with more than the BCG tuberculosis prevansiyonunda the most effective and cheapest method. Families of tuberculosis, some patients or hospital personnel working in and sanatoryumlarda and danger of infection in these areas with more new doğmuşlara, BCG vaccine should be made to children and adults. The incidence of tuberculosis is higher in patients with diabetes and diabetes patients, especially children, the tuberculin reaction is negative, BCG vaccination should be done.
Treatment
Active tuberculosis infection mainly 3 groups of bacilli proliferate lesion:
1. Kavernlerde growing lesions such as extracellular bacilli. This growing bacilli in lesions is more than the other lesions.
2. Bacilli growing in macrophages.
3. Solid caseous nodular lesions and proliferating bacilli.
Antituberculosis drugs, alone, rifampin (R) 3 group of bacteria population is an effective bactericidal drug. Isoniazid (H) and extracellular (Intracavernous lesions), and the bacteria within macrophages bactericidal effect. Streptomycin (S), the only extracellular bacteria, bactericidal effect. Pyrazinamide (Z), intracellular bacteria, bactericidal effect. With similar molecular structures, such as streptomycin and kanamycin kapreomisin medicines given by injection show the extracellular domain. Ethambutol (E), etyonamid, paraaminosalisilik acid and cycloserine antitübeküloz drugs as well as other bacteria-Eustatic act.
Turkey accordance with the terms of the duration of treatment 9-12 months. Treatment, S, N, R and Z start with. 1-2 months after treatment, this quartet is cut Q and R, H, M to change according to the triple-drug treatment period, cases completed in 9-12 months. As a result of drug sensitivity of cultured bacteria studied drugs changed if necessary. 30% of newly diagnosed cases in Turkey-40 has one or more drug resistance. Both the diagnostic and treatment success in terms of culture and drug sensitivity analysis of mycobacterium tuberculosis etmemeledir neglect. R and H is the most effective drugs in the treatment of tuberculosis. If you have resistance to one or both of these drugs is longer than the duration of treatment. This is the best decision about bacteriological, clinical and radiological findings are according to the situation. Such as the short-term treatment of patients for 6 months basillerinin must be sensitive to all drugs used. A short period of time, especially for the treatment of drug resistance in the R & H and lack of culture-negative bacilli should be at the end of 2 months of treatment.
Both isoniazid and rifampin hemde be given three antituberculosis drugs in patients with sensitive bacilli in 12-18 months of treatment is continued.
Extrapulmonary tüberkülozlarda duration of treatment 12-18 months or longer. Evaluation is carried out according to the seriousness of the disease and treatment outcome.
BCG "Basil-Calmette-Guerin" stands for the words. BCG tuberculosis bacilli Calmette and Guerin called investigators bovinus type of feeding over the years from producing a bacillus that reduced their virulence. This is to prevent tuberculosis infection or infection with bacilli vaksinasyonu light passes. Mechanism of action similar to the flower vaccine: a non-virulence organism brought husule lesion subsequent virulent infection provides a protective effect. Useful in protecting against disease, mass BCG tuberculosis vaccine. In this regard, BCG has been a good result in Turkey.
0.1 BCG is injected into the lower deltoid region intradermik. 3-4 weeks after vaccination, a papule husule income, a few weeks later, the papule appears, and passes through a slight ulceration. Sometimes the adjacent lymph nodes may be a slight growth. After about 3 months from the BCG tuberculin test is positive. BCG on the location of secondary infection, abseleşme rarely, very rarely occurs in the local lupoid reaction. Rarely, erythema nodosum, and urticaria may husule. 2% of all complications, the ratio of the uncertain nature and the vast majority of them.
Incidence of tuberculosis in countries with more than the BCG tuberculosis prevansiyonunda the most effective and cheapest method. Families of tuberculosis, some patients or hospital personnel working in and sanatoryumlarda and danger of infection in these areas with more new doğmuşlara, BCG vaccine should be made to children and adults. The incidence of tuberculosis is higher in patients with diabetes and diabetes patients, especially children, the tuberculin reaction is negative, BCG vaccination should be done.
Treatment
Active tuberculosis infection mainly 3 groups of bacilli proliferate lesion:
1. Kavernlerde growing lesions such as extracellular bacilli. This growing bacilli in lesions is more than the other lesions.
2. Bacilli growing in macrophages.
3. Solid caseous nodular lesions and proliferating bacilli.
Antituberculosis drugs, alone, rifampin (R) 3 group of bacteria population is an effective bactericidal drug. Isoniazid (H) and extracellular (Intracavernous lesions), and the bacteria within macrophages bactericidal effect. Streptomycin (S), the only extracellular bacteria, bactericidal effect. Pyrazinamide (Z), intracellular bacteria, bactericidal effect. With similar molecular structures, such as streptomycin and kanamycin kapreomisin medicines given by injection show the extracellular domain. Ethambutol (E), etyonamid, paraaminosalisilik acid and cycloserine antitübeküloz drugs as well as other bacteria-Eustatic act.
Turkey accordance with the terms of the duration of treatment 9-12 months. Treatment, S, N, R and Z start with. 1-2 months after treatment, this quartet is cut Q and R, H, M to change according to the triple-drug treatment period, cases completed in 9-12 months. As a result of drug sensitivity of cultured bacteria studied drugs changed if necessary. 30% of newly diagnosed cases in Turkey-40 has one or more drug resistance. Both the diagnostic and treatment success in terms of culture and drug sensitivity analysis of mycobacterium tuberculosis etmemeledir neglect. R and H is the most effective drugs in the treatment of tuberculosis. If you have resistance to one or both of these drugs is longer than the duration of treatment. This is the best decision about bacteriological, clinical and radiological findings are according to the situation. Such as the short-term treatment of patients for 6 months basillerinin must be sensitive to all drugs used. A short period of time, especially for the treatment of drug resistance in the R & H and lack of culture-negative bacilli should be at the end of 2 months of treatment.
Both isoniazid and rifampin hemde be given three antituberculosis drugs in patients with sensitive bacilli in 12-18 months of treatment is continued.
Extrapulmonary tüberkülozlarda duration of treatment 12-18 months or longer. Evaluation is carried out according to the seriousness of the disease and treatment outcome.
Tuberculin Skin Test (PPD)
Tuberculin Skin Test (PPD)
Important in the diagnosis of new cases of tuberculosis disease and the differential diagnosis and a specific test. Furthermore, prophylactic treatment with isoniazid help decide. The most widely used are two types of tuberculin: 1 Tuberculin OT (old tuberculin = old tuberculin) 2 PPD (purified protein derivative = pure protein derivative). PPD is prepared in a standard way for people to another is preferred. The most widely used method for tuberculin test intradermik injection. This is called the Mantoux test. Mantoux test is essential for the forearm flexor surface of the skin after cleaning 0.1 to 5 units of PPD or OT intradermik is injected.
Interpretation of Mantoux tuberculin test intradermik 48 or 72 hours after injection of 10 mm or more induration (papules), a positive reaction.
Tuberculin sensitivity of becoming infected with M.tüberkülosis 2-8 weeks (average 6 weeks) and then develops. A positive tuberculin test, that person is infected with Mycobacterium tuberculosis, husule indicates that the sensitivity, but it does not mean disease. Husule the sensitivity is usually permanent. Heavy seyderen diseases, measles, or smallpox vaccine flowers, high fever, sarcoidosis, advanced tuberculosis, leukemia, lymphoma, Hodgkin's, severe malnutrition, cachexia, advanced age, immunosuppressive drugs such as corticosteroids, uncontrolled diabetes, and alcoholism with the tuberculin sensitivity is reduced or temporarily lost. Tuberculosis infection is the tuberculin skin test may be negative or passed, though, it is called a false negative tuberculin test. Technical error, measurement and interpretation errors related. The tests may be negative bacilli taken up to 2-8 weeks, enough time to geçmemiştir sensitivity. Tuberculin skin test is positive after a while edilince again.
BCG vaccination in those would be positive tuberculin.
Milyer tuberculosis, meningitis, serious diseases such as tuberculosis and more rarely, may be negative tubercle in tuberculosis pleurisy. Receipt of the required immunosuppression therapy to control tuberculosis infection positive tuberculin is recovered.
Other laboratory examination
Many times is normal leukocytes. Some 10,000 to 15,000 patients to increase. Less than 10% monocytes. Normocytic anemia, reduction of serum albumin and serum globulin are increased. Increased sedimentation rate. Hematuria, or urine of renal tuberculosis may be related to inflammation.
Facilitating factors of tuberculosis disease
These factors examined in 3 main groups: 1 Source of infection. 2 The amount and virulence of bacteria. 3. Infected person's resistance.
The main source of infectious tuberculosis patients balgamıdır source of infection. Coughing, sneezing, talking loudly, singing, droplets of the bacilli in the sputum of tuberculosis infection can be transmitted by inhaled by others. Routinely used by the patients and careful cleaning of goods generally prevents contamination.
The amount of bacteria and the number of bacterial virulence and virulence received more basillerle-infected persons with tuberculosis disease increases the chance.
An infected person's resistance to the age of cases of primary tuberculosis, such as tuberculosis and meningitis milyer rate is more serious types of hematogenous tuberculosis. Menopause and the first three months of pregnancy and after birth andrapoz periods and increases the chance of tuberculosis.
Environmental factors
Toxic factors such as smoking and alcohol consumption increases the incidence of tuberculosis and reduce the chance of treatment. Areas, such as immunosuppressive drugs in patients undergoing long-term corticosteroid therapy increases the possibility of tuberculosis.
Tuberculosis incidence of diseases is high
There is an inverse relationship between diabetes mellitus and tuberculosis.
That is higher than the incidence of diabetes in patients with tuberculosis. And the development of diabetes in patients than tuberculosis rate is monitored. The possibility of not responding to treatment of diabetes mellitus in patients with tuberculosis should be examined carefully. The symptoms of diabetes or a family member with suspected tuberculosis, especially in patients with diabetes, fasting blood sugar should be consulted. Diabetes glucose tolerance test, fasting blood sugar is normal should be investigated. Chest radiographs of patients with diabetes lower lobe-tuberculosis cases of tuberculosis disease is more common in other locations. Therefore, the lower lobes of adult tuberculosis in an individual diagnosed diabetes kuşkulanmalıdır edilince.
High incidence of tuberculosis in patients with silicosis.
Hypothyroidism, measles and whooping cough disease resistance of tuberculosis infection is reduced.
Gastrectomy in cases of eating disorders is more associated with tuberculosis insidenisinin. The patients for surgical intervention, especially those with abdominal surgery, the chest radiograph should be drawn before the surgery.
Cancer, Hodgkin's, leukemia and other diseases debilitan increases the incidence of tuberculosis, related to a reduction in resistance to infection.
Increased incidence of tuberculosis in patients undergoing renal transplantation, immunosuppressive therapy, and hospital personnel related to contamination.
Sarcoidosis is a relationship between disease and atypical tuberculosis husule mikobakteriumla sarcoidosis has been suggested to come. This relationship is proven objectively. But more important is that the incidence of tuberculosis in patients with sarcoidosis, an observation. This should consider the possibility of sarcoidosis patients in the prophylactic treatment of tuberculosis and treatment of corticosteroid should be applied.
Higher incidence of tuberculosis in AIDS patients and many times relates to a type of atypical mycobacterium. PPD is often negative in patients with AIDS. Lymphadenopathy in patients with AIDS, tuberculosis, extrapulmonary tuberculosis more frequently being monitored and other tüberkülozlardan Intracavernous less.
Important in the diagnosis of new cases of tuberculosis disease and the differential diagnosis and a specific test. Furthermore, prophylactic treatment with isoniazid help decide. The most widely used are two types of tuberculin: 1 Tuberculin OT (old tuberculin = old tuberculin) 2 PPD (purified protein derivative = pure protein derivative). PPD is prepared in a standard way for people to another is preferred. The most widely used method for tuberculin test intradermik injection. This is called the Mantoux test. Mantoux test is essential for the forearm flexor surface of the skin after cleaning 0.1 to 5 units of PPD or OT intradermik is injected.
Interpretation of Mantoux tuberculin test intradermik 48 or 72 hours after injection of 10 mm or more induration (papules), a positive reaction.
Tuberculin sensitivity of becoming infected with M.tüberkülosis 2-8 weeks (average 6 weeks) and then develops. A positive tuberculin test, that person is infected with Mycobacterium tuberculosis, husule indicates that the sensitivity, but it does not mean disease. Husule the sensitivity is usually permanent. Heavy seyderen diseases, measles, or smallpox vaccine flowers, high fever, sarcoidosis, advanced tuberculosis, leukemia, lymphoma, Hodgkin's, severe malnutrition, cachexia, advanced age, immunosuppressive drugs such as corticosteroids, uncontrolled diabetes, and alcoholism with the tuberculin sensitivity is reduced or temporarily lost. Tuberculosis infection is the tuberculin skin test may be negative or passed, though, it is called a false negative tuberculin test. Technical error, measurement and interpretation errors related. The tests may be negative bacilli taken up to 2-8 weeks, enough time to geçmemiştir sensitivity. Tuberculin skin test is positive after a while edilince again.
BCG vaccination in those would be positive tuberculin.
Milyer tuberculosis, meningitis, serious diseases such as tuberculosis and more rarely, may be negative tubercle in tuberculosis pleurisy. Receipt of the required immunosuppression therapy to control tuberculosis infection positive tuberculin is recovered.
Other laboratory examination
Many times is normal leukocytes. Some 10,000 to 15,000 patients to increase. Less than 10% monocytes. Normocytic anemia, reduction of serum albumin and serum globulin are increased. Increased sedimentation rate. Hematuria, or urine of renal tuberculosis may be related to inflammation.
Facilitating factors of tuberculosis disease
These factors examined in 3 main groups: 1 Source of infection. 2 The amount and virulence of bacteria. 3. Infected person's resistance.
The main source of infectious tuberculosis patients balgamıdır source of infection. Coughing, sneezing, talking loudly, singing, droplets of the bacilli in the sputum of tuberculosis infection can be transmitted by inhaled by others. Routinely used by the patients and careful cleaning of goods generally prevents contamination.
The amount of bacteria and the number of bacterial virulence and virulence received more basillerle-infected persons with tuberculosis disease increases the chance.
An infected person's resistance to the age of cases of primary tuberculosis, such as tuberculosis and meningitis milyer rate is more serious types of hematogenous tuberculosis. Menopause and the first three months of pregnancy and after birth andrapoz periods and increases the chance of tuberculosis.
Environmental factors
Toxic factors such as smoking and alcohol consumption increases the incidence of tuberculosis and reduce the chance of treatment. Areas, such as immunosuppressive drugs in patients undergoing long-term corticosteroid therapy increases the possibility of tuberculosis.
Tuberculosis incidence of diseases is high
There is an inverse relationship between diabetes mellitus and tuberculosis.
That is higher than the incidence of diabetes in patients with tuberculosis. And the development of diabetes in patients than tuberculosis rate is monitored. The possibility of not responding to treatment of diabetes mellitus in patients with tuberculosis should be examined carefully. The symptoms of diabetes or a family member with suspected tuberculosis, especially in patients with diabetes, fasting blood sugar should be consulted. Diabetes glucose tolerance test, fasting blood sugar is normal should be investigated. Chest radiographs of patients with diabetes lower lobe-tuberculosis cases of tuberculosis disease is more common in other locations. Therefore, the lower lobes of adult tuberculosis in an individual diagnosed diabetes kuşkulanmalıdır edilince.
High incidence of tuberculosis in patients with silicosis.
Hypothyroidism, measles and whooping cough disease resistance of tuberculosis infection is reduced.
Gastrectomy in cases of eating disorders is more associated with tuberculosis insidenisinin. The patients for surgical intervention, especially those with abdominal surgery, the chest radiograph should be drawn before the surgery.
Cancer, Hodgkin's, leukemia and other diseases debilitan increases the incidence of tuberculosis, related to a reduction in resistance to infection.
Increased incidence of tuberculosis in patients undergoing renal transplantation, immunosuppressive therapy, and hospital personnel related to contamination.
Sarcoidosis is a relationship between disease and atypical tuberculosis husule mikobakteriumla sarcoidosis has been suggested to come. This relationship is proven objectively. But more important is that the incidence of tuberculosis in patients with sarcoidosis, an observation. This should consider the possibility of sarcoidosis patients in the prophylactic treatment of tuberculosis and treatment of corticosteroid should be applied.
Higher incidence of tuberculosis in AIDS patients and many times relates to a type of atypical mycobacterium. PPD is often negative in patients with AIDS. Lymphadenopathy in patients with AIDS, tuberculosis, extrapulmonary tuberculosis more frequently being monitored and other tüberkülozlardan Intracavernous less.
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.
Laboratory
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.
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.
Laboratory
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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