Fibrous-cavernous tuberculosis: symptoms and treatment. Prevention and useful advice

Fibrous-cavernous pulmonary tuberculosis is a destructive disease characterized by the presence of an isolated cavity in the lungs. In medicine, it was called "cavern."The disease is a stage in the progression of pulmonary tuberculosis. Often, the clinic of such a pathology has an erased character.

Features of the disease

As a rule, fibro-cavernous tuberculosis is observed in adult patients. In childhood, primary tuberculosis manifestations are very rare.

Cavernous pathology acts as the outcome of infiltrative tuberculosis, but it happens that a disseminated, or focal, type of pathology develops.

Fibrous-cavernous form is detected in 5% of cases of tuberculosis.

Cavernous tuberculosis as a step towards the development of fibro-cavernous pathology

A characteristic pathomorphological feature of cavernous tuberculosis is the presence of a single cavity, absence of inflammation and fibrotic changes in the area of ​​bronchi, lymphatic vessels and nearby tissue. The disease lasts no more than 2 years.

Cavity healing occurs with the formation of:

• scar;
• tuberculomas;
• single source of tuberculosis;
• sanitized cavity.

In the absence of proper therapy, the cavernous form can pass into fibro-cavernous tuberculosis, which is characterized by fibrosis of the walls of the cavity and the nearby pulmonary parenchyma. There are also multiple foci of dissemination.

Symptoms of the disease

As a rule, fibrous-cavernous tuberculosis is located in one lung. The development of the disease occurs for 3-4 months of ineffective therapy of another type of tuberculosis. Manifestations of the disease become particularly vivid in the phase of decay.

The following are the main symptoms of the disease:

• asthenia;
• loss of appetite;
• mild cough with phlegm;
• expectoration of blood;
• bleeding;
• wet rales in the decay cavity.

After the formation of the cavern, the symptoms become meager, less pronounced and nonspecific. The patient can complain of general weakness, constant fatigue, weight loss and the presence of subfebrile temperature.

The development of a latent form of tuberculosis can be indicated by bleeding in the lungs, which develops without a cause.

Anamnesis of patients afflicted with fibro-cavernous tuberculosis, assumes a wavy course. The intervals between the acute period and remission can be quite long or, conversely, the acute phase can manifest itself quite often.

Fibrous-cavernous form of tuberculosis has various clinical symptoms. It is caused by the pathological process itself, as well as by concomitant complications.

There are two types of the course of the disease: limited or relatively stable, under which chemotherapy is followed by stabilization of the patient's condition and remission that lasts for several years.

In acute period there is a rise in temperature and development of the inflammatory process around the cavity. The temperature can reach high values ​​if an infection of a secondary nature joins the underlying disease.

Lesion of the bronchi is accompanied by a painful nausea cough, in which a sputum containing mucus and pus separates with difficulty.

A patient suffering from fibrous-cavernous tuberculosis, sharply loses weight. He has dry skin, which easily wrinkles. The patient's muscles are atrophied. The target of the pathological process is the shoulder girdle, the back and the area between the ribs.

Patients are prone to frequent intoxication. With exacerbations of the disease, respiratory failure of 1 and 2 degrees develops. In the future, there may be an increase in the volume of the liver. There may be swelling.

When the disease progresses, laryngeal and intestinal lesions are noted, which leads to weakening of the immune system. With kahesia, amyloid nephrosis and pulmonary heart disease, the prognosis of the disease is unfavorable.

Causes of the disease

The destruction can be provoked in any clinical form of tuberculosis. A provoker of development may be superinfection. To pathogens should be attributed mycobacteria. In all there are 74 names. They belong to the genus Mycobacterium. However, tuberculosis in humans is provoked by a conditionally designated type, called Mycobacterium tuberculosis.

Predisposing factors of the development of the disease are:

• increase in the level of sensitization;
• changes in the reactivity of the body;
• diseases of internal organs;
• is a bad habit.

Main phases of the disease

The following phases of fibro-cavernous tuberculosis have been identified:

• Infiltration. It assumes the presence of a focus of inflammation.
• Disintegration. In the focus of inflammation a cavity is formed, which is filled with a special form of necrotic tissue - a caseous mass. The dry contents become liquid and gradually torn off through the draining bronchus. In its place remains a cavity. In the future, it begins to fill with air, and if there is a violation of drainage in the bronchi, it becomes liquid.
• Education of caverns. Formation is formed by resolution of perifocal inflammation and fibrosis. The wall of the anomaly contains three layers. The inner layer is represented by a caseous mass( polygenic layer).In the middle there is a granulation shell lined with large epithelial cells. From the outer part of the cavity is covered with a capsule of connective tissue.
• Insemination. In this process, the dimensions of the cavity increase, and around it there is perifocal infiltration, or seeding. The process involves the development of fresh inflammatory foci in cavernous tuberculosis. This is how the fibrous-cavernous form of the disease develops.

Common complications of

The following complications of fibro-cavernous tuberculosis are distinguished:

• Hemoptysis.
• Bleeding in the lung.
• Presence of percussion. It is expressed in the shortening of sound in the areas of thickened pleura and fibrosis.
• Listening to weak breathing in areas of thickening of the pleura. Also, wet wheezing and bronchial breathing are detected. Such rales are detected in the presence of large cavities. Over small formations, sounds differ in lesser voicedness.

Diagnostic methods

How is fibro-cavernous tuberculosis diagnosed? The history of the disease at the time of diagnosis, as a rule, already contains information about a previously transmitted tuberculosis infection.

It should be noted that auscultative symptoms carry little information. Further examination by X-ray reveals the presence of ring-shaped shadows with a peripheral arrangement in the shape of an oval or a circle. After the data obtained by X-ray diffraction, differential diagnostics with a pathology such as lung abscess, peripheral cancer, bullous emphysema, pneumothorax, echinococcosis, or digested pleurisy is required.

Laboratory and endoscopic methods serve as auxiliary diagnostic methods.

Sputum analysis reveals a high level of MTB.At laboratory inspection the high level of allocation of bacilli is revealed. Sometimes the process becomes intense. Coral elastic fibers are also identified.

In the absence of sputum, bronchoscopy is indicated. It allows to identify the foci of inflammation in the lungs and bronchi, which prevent the closure of the cavity.

Blood test. In patients with fibro-cavernous tuberculosis there is lymphopenia and an accelerated index of ESR up to 30-40 mm / h.

In secondary infection there is an increase in the level of leukocytes to a value of 19 000-20 000, as well as an increase in the level of neutrophils.

High protein content in urine is noted.

Principles of therapy for

How is fibro-cavernous tuberculosis eliminated? Treatment is conducted in a hospital in TB dispensaries.

The scheme of therapy is based on the simultaneous use of three or four drugs directed against the development of pathology. As a rule, Isoniazid, Etambutol, Rifampicin and Streptomycin are used. Drugs can be injected intravenously or directly into the cavity of the cavity.

Tuberculotherapy, respiratory gymnastics, physiotherapeutic procedures, laser treatment, ultrasound and inductothermy are also used.

Conducting chemotherapy

How else is fibro-cavernous pulmonary tuberculosis eliminated? Treatment involves chemotherapy. The procedures are assigned on an individual basis in accordance with the sensitivity indicators for medicines.

As a rule, in the presence of resistance to fixed assets against tuberculosis, therapy is performed in accordance with the fourth regimen of chemotherapy. Treatment involves the combined use of drugs such as Kanamycin, Prothionamide, Cycloserine, PASK and Fluoroquinolone. The duration of chemotherapy is no less than 15-18 months.

Patients with the presence of fibro-cavernous tuberculosis are shown pathogenetic therapy, which is aimed at correction of various disturbed functions of the body. Metabolizing agents, as well as drugs for restoring the immune system and hormones are used.

With a favorable course of therapy, after about six months, a positive trend is observed. There is a reduction in the release of bacilli, as well as a decrease and closure of the cavern.

Operative intervention

The healing of fibrous cavities is always very slow. If during the above-mentioned period it is not possible to achieve positive results, fibro-cavernous pulmonary tuberculosis is eliminated through surgical intervention. In this case, a one-sided resection of the lung is indicated. The operation is carried out also in the bilateral process. It also features a high degree of efficiency and allows you to maintain the patient's ability to work. The life expectancy of a sick person is significantly longer. Isolation of mycobacteria ceases.

Another type of surgical intervention is surgical collapse, assuming the imposition of an artificial pneumothorax.

After treatment in hospital conditions, compulsory stay in a sanatorium, out-patient treatment with subsequent supervision in the dispensary is required.

Prognosis of the disease

The overwhelming majority of fibro-cavernous tuberculosis lends itself to therapy. Caverns of small size are closed and scarred. Formations with the presence of rigid walls with time are again filled with caseous contents, which provokes the development of pseudotuberculoma.

The accumulation of pus, the presence of aspergillosis, the progress of tuberculosis are extremely rare.

Preventative measures

Fibrous-cavernous pulmonary tuberculosis belongs to the category of diseases caused by unfavorable social factors. Often, the primary cause is deterioration in the living standards of the population.

According to statistics, men get sick 3 times more often than women. In general, the pathology is fixed between the ages of 20 and 39 years.

For the purpose of prevention, the following rules are recommended:

• conducting appropriate preventive measures;
• early detection of people affected by the disease;
• state allocation of funds for medicines;
• the implementation of preliminary medical examinations when entering work in livestock farms;
• increase in the area of ​​residence for patients who have been diagnosed with tuberculosis;
• timely delivery of vaccination to newborn babies in the first month after birth.

Conclusion

Fibrous-cavernous pulmonary tuberculosis( complications pose a threat to health) is a chronic disease. As a rule, it is provoked by cavernous tuberculosis. The disease can be a one-sided or two-sided lesion.

If earlier pathology was difficult to treat, then at present medicine has a wide range of different therapeutic methods that allow achieving a stable remission for many years. Timely therapy allows to maintain the patient's ability to work.