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General medical doctors, health care managers, and preventive medicine specialists are constantly faced with the problem of tuberculosis, so knowledge of the main sections of phthisiology is necessary.

The proposed book was prepared in accordance with the phthisiology program for students of higher medical educational institutions of the Republic of Belarus. It presents basic information on the history of phthisiology, and also highlights a section concerning the history of the fight against tuberculosis in Belarus.

The clinical and radiological picture of infiltrative pulmonary tuberculosis has much in common with a number of diseases, primarily with the presence of limited or extensive infiltrate-like shadow formations in the lung tissue. These are various nonspecific pneumonias: lobar, focal, allergic, viral, viral-bacterial or bacterial origin, abscess and infectious destruction of the lung, central, and occasionally peripheral lung cancer, especially with the presence of hypoventilation or atelectasis, pulmonary infarction with infarction pneumonia, some mycoses, in particular actinomycosis, etc.

Differential diagnosis of lobar pneumonia will be discussed below in the differential diagnosis with caseous pneumonia.

Most often in clinical practice it is necessary to carry out a differential diagnosis between infiltrative pulmonary tuberculosis (cloud-shaped, limited, hilar infiltrate, periscisuritis) and pneumonia.

The onset of the disease with pneumonia is more acute. Most often, a history of colds is noted, a runny nose, laryngitis, and tracheobronchitis appear. The temperature rises to 39 °C, occasionally higher, chills, headaches, shortness of breath, pain in the chest, sometimes in the joints and muscles are noted, and the general condition worsens significantly. In the anamnesis, there are usually no indications of contact with a patient or previous tuberculosis characteristic of tuberculosis; aggravating factors are less common, such as dependence on alcohol, stay in places of detention, etc. During auscultation, scattered dry sounds, as well as small and medium-sized bubbles, are heard. abundant moist rales, often in the lower and middle parts of the chest in the area where pneumonia is localized.

In patients with infiltrative tuberculosis, the onset of the disease is less acute, the symptoms of intoxication are less pronounced, the temperature is lower (37–38 °C), and symptoms of rhinitis and tracheobronchitis are less common. Patients with limited fresh infiltrative tuberculosis often have no complaints. Physical data are more scarce. In patients with tuberculosis, a small amount of fine moist rales is usually heard, and often no rales are detected at all.

In the blood of pneumonia, more pronounced leukocytosis (over 10 x 10 9 / l) and a shift of the leukocyte formula to the left are determined than with infiltrative tuberculosis. Mycobacterium tuberculosis is found in sputum or bronchial washings in most patients with infiltrative tuberculosis. In their absence, repeated examinations of the pathological material for CD are necessary, at least 810 tests; in case of pneumonia, the result is negative.

X-ray: the favorite localization for infiltrative tuberculosis is the area of ​​the 1st–2nd bronchopulmonary segment, less often the 6th segment, even less often in other parts of the lung, however, one should remember about the possibility of localizing the tuberculosis process in the lower parts of the lung, especially in old people. Characteristic lesions of the middle lobe (on the left - lingular zone) with “senile tuberculosis”.

Pneumonia is usually localized in the basal segments of the lower lobe, in the root zone. The presence of older tuberculous changes (petrificates, pleural overlays, etc.) is an additional argument in favor of the tuberculous etiology of the disease, although pneumonia can develop in the area of ​​old tuberculous changes. The presence of a decay cavity, fresh foci outside the pneumonic shadow or in another lung, leading “paths” to the root is characteristic of tuberculosis.

At the same time, with pneumonia, the shadow is often more homogeneous, closely associated with the root of the lung, the size of which can increase due to nonspecific adenitis, while with tuberculous infiltrate, especially cloud-like, it usually appears to consist of a number of merging foci.

An important diagnostic method is complex anti-inflammatory treatment, especially in the absence of an acute course of the disease, which currently often occurs in patients with pneumonia, especially in patients with reduced resistance, as well as in cases of an atypical pathogen (mycoplasma, chlamydia, legionella, etc. ). Repeated X-ray examination is usually carried out after 2 weeks (not earlier). During this period, pneumonic changes usually completely or significantly resolve, tuberculous changes are mostly preserved, and occasionally a slight decrease is observed. In these cases, it is advisable to extend anti-pneumonic treatment for another 10 days, conducting repeated studies of the material for CD during this period, as well as changing the method of antibiotic therapy, using, for example, macrolides, which are effective for mycoplasma pneumonia.

Sometimes there may be an acute onset with a rather severe course of the disease in the first days. Shortening of the percussion sound, weakened breathing, scattered dry and wet rales, variable in nature and prevalence, are detected in patients with more severe forms of the disease, more often physical data are scanty. ESR is within normal limits or slightly increased. Eosinophilia is found in peripheral blood, sometimes up to 30–50%. It should be noted that with allergic pneumonia, significant eosinophilia is not detected in all patients. Sputum is absent or released in small quantities, mucous, viscous, sometimes yellowish in color due to the presence of Charcot Leyden crystals, formed due to the breakdown of eosinophils. Mycobacterium tuberculosis is not detected.

X-rays reveal homogeneous darkening of various shapes (often round) and sizes with unclear contours; in some patients they are extensive, occupying an entire lobe or more; can be located simultaneously in both lungs. Decay cavities are usually absent, as is the “path” to the root. Sometimes a slight pleurisy is detected. Changes may be characterized by “volatility.” Disappearing in one place, they soon appear in another - “volatile eosinophilic infiltrate.”

The main distinguishing feature of allergic pneumonia is its rapid resorption within several days with the restoration of the normal pulmonary pattern, especially with proper treatment, when predominantly antiallergic therapy is prescribed. In tuberculosis, after involution of the infiltrate, fibrotic changes remain, often with the presence of foci.

Central lung cancer and tuberculosis in the initial stage can occur hidden. In the future, they are characterized by cough, hemoptysis, shortness of breath, fatigue, increased ESR, etc. However, lung cancer, more often than tuberculosis, begins in old age, although over the past decades it has been noted that cancer has become “younger.” Both diseases are more common in men, but for cancer this ratio is (8–10): 1, for tuberculosis on average 4:1, and even less at a young age. In the anamnesis of patients with lung cancer, chronic nonspecific respiratory diseases, long-term smoking are often noted; in case of tuberculosis, a previous process, contact with tuberculosis patients, and social risk factors. Central cancer begins more slowly than tuberculosis. With infiltrative tuberculosis, acute and subacute onset of the disease is not uncommon. As the process progresses, patients with lung cancer experience an increasing deterioration in their general condition: weakness, fatigue, weight loss. A cough that is dry or with a small amount of sputum is characteristic. Microhematoptoe is often observed, i.e. visually blood is not visible in the sputum, but microscopic examination constantly reveals red blood cells. When the tumor grows into the pleura, constant intense pain in the chest occurs. In patients with infiltrative tuberculosis, chest pain is aching and less intense.

The dullness of percussion sound in patients with lung cancer is more pronounced, and later, especially with the development of atelectasis, it turns into dullness. Characterized by a significant increase in ESR, up to 50 mm/h and above. In the sputum or bronchial lavage waters, during repeated examination, atypical cells are found in some patients (in case of infiltrative tuberculosis, MBT is found quite often). X-rays reveal changes in the hilar zone, with upper lobe localization, more often in the 3rd segment (Fig. 70). The outer contour of the shadow (node) is fuzzy, uneven, characterized by the presence of radiant cords, depending on cancerous lymphangitis (the “crow’s foot” symptom, “rising sun”), areas of hypoventilation, which can be mistaken for tuberculous or pneumonic foci, especially since paracancrosis often occurs pneumonitis

As a result of anti-inflammatory treatment, it is possible to obtain temporary positive dynamics associated with the resorption of pneumonitis, a decrease in hypoventilation due to the elimination of edema around the cancerous node in the bronchus or the disintegration of the tumor and an improvement in bronchial patency in this regard. However, after some time, hypoventilation is detected again, and then atelectasis develops, which is much more common in cancer than in tuberculosis, with endobronchial tumor growth, and later with exobronchial growth.

In patients with infiltrative tuberculosis, heterogeneous shadow formations (racillary forms of infiltrates) are revealed, often with a “path” to the root of the lung, and the shadow of the root itself, unlike cancer, is not enlarged. Much more often the presence of decay and bronchogenic contamination is detected. Changes in the area of ​​the lung root, the presence of a node, a violation of the structure of the bronchial tree are detected on a tomogram, and much better with computed tomography (Fig. 71. 72). Bronchoscopy is important to detect a tumor or narrowing and decreased mobility of the bronchus. A biopsy of material from the affected area, taken during bronchoscopy, confirms the diagnosis. Bronchography reveals a filling defect in the tumor area, and if the bronchial lumen is closed, only its proximal section is filled with contrast. If cancer is suspected, a comprehensive examination is necessary to identify possible metastases.

In rare cases, pneumonia-like cancer (Pancoast tumor) develops in the area of ​​the apex of the lung, which is characterized by the development of an infiltrative shadow with fairly rapid germination into the pleura and surrounding tissues, which leads to severe pain and atrophy of the arm muscles.

Often persistent recurrent pleurisy with hemorrhagic exudate, in which atypical cells are also found (see also differential diagnosis between round infiltrate or tuberculoma and peripheral cancer). In unclear cases, videothoracoscopy with biopsy is indicated.

Due to changes in the course of a lung abscess towards a decrease in acute clinical manifestations, difficulties often arise in its differential diagnosis with infiltrative tuberculosis in the decay phase. Common symptoms are: fever, cough with sputum, sometimes hemoptysis, disturbance in general condition, the presence of wheezing, changes in the hemogram, identification of a decay cavity during X-ray examination.

At the same time, differences in the history of the disease are characteristic. Its more acute onset is observed with an abscess with pronounced clinical manifestations: higher temperature than with tuberculosis, chills and sweats. Leukocytosis at the onset of the disease is often high up to (15-20) x 10 9/l, the ESR is sharply increased, and there is a pronounced shift in the leukocyte formula to the left. At the moment the abscess breaks, a significant amount of purulent sputum is released, often with a putrid odor, which helps the correct diagnosis, since with tuberculosis the sputum is odorless. Various-sized moist, often sonorous wheezing, often in the middle and lower parts of the lungs, is characteristic of an abscess.

X-ray examination in typical cases reveals a decay cavity with the presence of a horizontal fluid level, which is rare in tuberculosis, with a wide band of shading around the cavity, a blurred outer and uneven inner contour, localized in the middle parts of the lung (Fig. 73). Usually there are no old focal changes or foci of bronchogenic contamination.

Elastic fibers are found in the sputum, but MBT are absent. Tuberculin tests are often negative. It is especially difficult to differentiate a cavity of nonspecific etiology from tuberculosis when it is located in the upper parts of the lungs, there is no fluid level, and with mild clinical manifestations.

In these cases, repeated examinations of sputum and bronchial washings for MBT, a careful study of the x-ray picture, indicating the absence of old and fresh tuberculous foci around the cavity and in other parts of the lungs, help. However, the main role in such patients, and often in general in the differential diagnosis of a lung abscess, is played by complex anti-inflammatory treatment, which leads to healing of the cavity or its rapid reduction and resorption of pneumonic changes. In the presence of cavity formation and anti-inflammatory treatment, it is advisable to carry out a control X-ray examination no earlier than after 2–3 weeks (Fig. 74).

Pulmonary infarction sometimes has to be differentiated from infiltrative tuberculosis, especially when it is complicated by infarction-pneumonia. The development of pulmonary infarction is associated with thromboembolism of the branches of the pulmonary or bronchial arteries.

The history of patients with pulmonary infarction reveals phlebitis, thrombophlebitis, especially of the deep veins of the lower extremities, a history of rheumatism, and myocardial infarction. The disease begins acutely, characterized by chest pain, often severe, and hemoptysis is much more common than with infiltrative tuberculosis. An increase in temperature may not be observed from the first day. Pulmonary infarction is often complicated by pleurisy, and first a pleural friction rub is heard, then weakened breathing. The nature of the exudate in most cases is hemorrhagic. Mycobacterium tuberculosis is not detected in sputum; tuberculin tests may be negative. Coagulogram data indicate a tendency towards hypercoagulation. X-ray in various parts of the lungs during a heart attack reveals one or several shadows, usually triangular in shape, located in different parts of the lungs, without destruction; there are no recent or old focal changes. Anticoagulant therapy in combination with anti-aneumonic treatment appears to be effective.

Actinomycosis of the lung sometimes resembles infiltrative tuberculosis. There are several forms: infiltrative, solitary, widespread, etc. At the onset of the disease, the temperature rises, a cough with sputum appears, hemoptysis and weakness are possible. Dullness of percussion sound and moist rales are detected. In the blood: increased ESR, moderate leukocytosis, shift of the leukocyte formula to the left. X-ray: focal shadows of infiltrative type, mainly in the lower parts of the lung and close to its root. Foci of bronchogenic contamination are not detected; fibrotic changes, bronchiectasis, and sometimes cyst-like thin-walled cavities are detected. As the process progresses, coughing, purulent sputum production and chest pain intensify, and the temperature becomes febrile. On X-ray examination, areas of destruction appear in the lungs, and dry or exudative pleurisy may develop. The process may transfer to the chest. Then infiltrates that are dense to the touch develop, fistulas appear with the release of pus. It is necessary to examine sputum and discharge from fistulas, in which drusen of actinomycetes are detected.

The onset of lobar pneumonia is most often acute, with almost no prodromal symptoms. Tuberculous lobitis can also begin acutely, but often there is a more gradual onset; with caseous pneumonia, the onset is also acute. The general condition of patients with lobar pneumonia is more severe: chills, temperature up to 39–40 ° C, severe shortness of breath, chest pain, catarrh of the upper respiratory tract, herpes on the lips. Patients have a feverish flush and a dry tongue. Viscous, often rust-colored sputum is produced. Patients with infiltrative tuberculosis, even of the lobita type, feel better, the manifestations of intoxication are less pronounced, the temperature is 38–39 ° C, low-grade. With caseous pneumonia, the condition is also severe, intoxication syndrome (high temperature, sweats, shortness of breath, chest pain, etc.) is significantly expressed, but the presence of herpes and catarrh of the upper respiratory tract is not typical. Hemoptysis in the form of streaks of blood in the sputum or pulmonary hemorrhage may be observed. Lobar pneumonia is characterized by rust-colored sputum, which is relatively rare in caseous pneumonia. In case of caseous pneumonia, MBT is detected in the sputum. However, their absence in the initial period does not in itself exclude the tuberculous etiology of the disease, since MBT can be detected later - even after 10–15 days. Therefore, repeated examinations of sputum (wash water) for CD using various methods are mandatory. Nevertheless, in the sputum of extensive infiltrative processes and caseous pneumonia, MBT is almost always found; in lobar pneumonia, another microbial flora, most often coccal, is found. In patients with lobar pneumonia, ESR and especially leukocytosis are higher than in infiltrative tuberculosis. On physical examination, the dullness of percussion sound is more significant in patients with lobar pneumonia in the stage of hepatization. Auscultation at the beginning of the disease reveals crepitus (indux), then in the hepatization stage there are no catarrhal phenomena, and finally, in the resolution stage crepitus (redux) reappears. Breathing in the hepatization phase is bronchial. Bronchophony is significantly enhanced. Infiltrative tuberculosis (lobitis) is characterized by the presence of small and medium-sized moist rales. With caseous pneumonia, already in the first days, moist small- and then medium-bubble rales, quite sonorous, are heard. With the formation of decay cavities they become more abundant. Radiologically, with lobar pneumonia, a homogeneous darkening is determined within the lobe, usually the lower one. For infiltrative tuberculosis and caseous pneumonia, upper lobe localization is more typical. In patients with caseous pneumonia, more than one lobe is often affected; in almost half of the cases the process is bilateral, bronchogenic contamination is pronounced, which is not typical for lobar pneumonia. Shadow formations are usually heterogeneous. Several small cavity formations quickly appear in various areas, which, as the caseous masses are rejected, merge into large and even giant cavities.

In the blood, in both diseases, leukocytosis is observed with a shift in the leukocyte formula to the left; it is usually higher in lobar pneumonia. Lymphopenia is pronounced. With caseous pneumonia, a fairly rapid development of anemia is possible. The nature of tuberculin tests is not significant. Negative anergy is possible in both diseases.

Anti-inflammatory treatment with antibiotics and pathogenetic therapy leads to a rapid improvement in the general condition of patients with lobar pneumonia and resolution of changes in the lungs.

For tuberculosis, such treatment is ineffective. The patient's condition quickly deteriorates, he weakens, profuse sweats, shortness of breath, tachycardia, and acrocyanosis appear. It should be emphasized that in severe cases with suspected caseous pneumonia, when it is dangerous to leave the patient without etiotropic therapy, it is necessary to prescribe broad-spectrum antibiotics, such as rifampicin, aminoglycosides, fluoroquinolones with control after an average of 2 weeks. During this period, with an extensive tuberculosis process, the x-ray dynamics will be insignificant, with pneumonia - pronounced until almost complete resorption.

Clinical and radiological manifestations of infectious destruction of the lungs are quite similar to caseous pneumonia: acute onset of the disease, pronounced manifestations of intoxication, the presence of dullness of percussion sound and moist rales during auscultation, heterogeneous, often extensive areas of darkening in the lungs with the presence of destruction. These patients are often sent to tuberculosis hospitals. When differential diagnosis, one should take into account medical history: presence of contact, tuberculosis in the past, aggravating factors (the latter can also occur during infectious destruction). For infectious destruction, the presence of inflammatory (purulent) foci in the body is important; it can be a manifestation of septicopyemia. The clinical picture is more severe with caseous pneumonia, intoxication syndrome increases faster. However, even in patients with infectious destruction, the severity of the condition is often significant. The most important diagnostic sign is bacterial excretion. In patients with caseous pneumonia, it is often not detected in the first days, so it is necessary to repeatedly examine sputum (washing water) for MBT using modern methods: fluorescent microscopy, possibly PCR. Blood tests for sterility are also indicated. X-ray examination may be of some help. The appearance of a significant number of small cavitary formations in areas of infiltration, bilateral massive dissemination in the lungs, and the presence of typical foci of bronchogenic contamination are more characteristic of caseous pneumonia. In unclear cases, computed tomography is appropriate. The effectiveness of the treatment may be of important diagnostic significance. The use of modern antibiotics: 3-4th generation cephalosporins, macrolides, tisnam against the background of pathogenetic therapy can give a fairly rapid clinical effect and radiological dynamics. However, in unclear cases, we must not forget about the need to prescribe anti-tuberculosis drugs (isoniazid, rifampicin), since untreated caseous pneumonia quickly progresses and leads to death.

Tuberculosis and pneumonia are very common diseases in Russia. They are similar in manifestations and also have an infectious nature. The causative agent of the first is always one of the types of mycobacteria that provoke the typical clinical picture of “consumption”.

And the term “pneumonia” is considered a general one, implying an illness that can be caused by cocci, Afanasyev-Pfeiffer bacillus, Legionella pneumophila, other bacteria and even viruses.

Clinical picture

Mortality from tuberculosis in Russia amounts to 25,000 people per year. There are often cases when, suspecting they have pneumonia, patients self-medicate. There is no improvement in the clinical picture, and at a late stage of the disease, when visiting a doctor, a completely different diagnosis emerges: pulmonary tuberculosis.

Severe consequences of the disease, including death, are caused by its untimely detection.

Whereas, if the diagnosis is made correctly at the beginning of the disease, the prognosis is much more favorable, and treatment is complicated by fewer side effects.

Tuberculosis and pneumonia have fundamentally different approaches to treatment. That is why these diseases must be clearly distinguished.

In most cases, it is possible to correctly assume tuberculosis or pneumonia based on the symptoms. Pneumonia begins with an acute period and develops rapidly. Most often, it becomes a complication of an untreated runny nose, bronchitis caused by influenza or another viral, and possibly bacterial infection of the respiratory tract. The cause may be a weakened immune system after chemotherapy or radiation therapy.

The disease is accompanied by high fever, severe cough with the discharge of sputum of a purulent or mucous nature. Temperature rises alternate with declines, as a result the patient feels;

• prostration;
• weakness;
• lethargy;
• chest pain;,
• shortness of breath that worsens when inhaling.

The course of tuberculosis at an early stage usually occurs unnoticed by the patient, and lung damage can only be detected by x-ray. Later, the disease makes itself felt by a cough that does not go away for 3-4 months with mucous, purulent-mucous sputum and blood. The temperature stays in the range of 37.1-38 degrees, accompanied by loss of appetite and weight loss. The cheeks take on a blush, and the eyes take on an unhealthy glaze. Symptoms appear in waves and are cyclical.

Sometimes tuberculosis develops quickly, like pneumonia. In such cases, the diagnosis will be determined by tests and radiography.

At the beginning of the 20th century, the “golden rule” of distinction using the auscultation method was derived. When listening with a stethoscope to the lungs of a patient with pneumonia, you can hear:

• a variety of wheezing, including moist fine bubbling wheezing;
• bronchial breathing;
• multiple clicks; occurring at the end of inspiration (crepitus).

In tuberculosis, breathing may correspond to a healthy state (vesicular breathing), moist rales are present in small quantities or are absent altogether.

Specifics of diagnosis and treatment

If the clinical picture of diseases during a physical examination does not always make it possible to immediately distinguish between diseases, then modern laboratory and instrumental methods make it possible to do this accurately. Laboratory diagnostics

To distinguish diseases, there are the following tests:

X-ray

X-rays are by far the most reliable method in diagnosing lung diseases. Their defeat is present in both cases, but the picture is significantly different.

Let's look at the main differences between these diseases in the pictures:

Infiltrates in tuberculosis depend on the form of the disease:

X-ray images can only be correctly interpreted by a specialist with experience in this field.

Therapy

The basis of treatment for all types of pneumonia is antibiotics. The choice of medicine is determined by the type of bacteria that caused the disease. With the right choice of remedy, on the 3rd day of illness there should be an improvement in the condition and normalization of the temperature.

In therapy, phlegm-thinning and bronchi-dilating drugs are also used, both orally and by inhalation. Part of the treatment is physiotherapy in the form of physical therapy and vibration massage.

Treatment of tuberculosis is a much longer procedure, including a 3-4 month hospital stay and several months of outpatient observation. Antibiotics are often powerless against mycobacteria, so 4th and 5th chemotherapy treatment regimens are used. In rare cases, advanced disease requires surgical intervention.

Timely consultation with a doctor and correct diagnosis, be it tuberculosis or a form of pneumonia, will speed up recovery and avoid serious consequences.

How to distinguish tuberculosis from pneumonia? Often an insidious disease is disguised as other diseases. Dangerous inflammation in tuberculosis and pneumonia has similar symptoms. Therefore, in order to find out what disease has settled in the body, it is necessary to undergo a full examination. With the results of the examination, go to a doctor who will interpret them correctly.

The clinical course of tuberculosis and pneumonia is similar. We have a lot of tuberculosis patients, but not everyone goes to the clinic. Some people simply do not know about their illness or mistake it for pneumonia. Let's try to figure out how to distinguish pneumonia from tuberculosis. A correct and timely diagnosis is very important. It will help you start treating the disease faster.

Symptoms of pneumonia:

• begins with a sharp increase in temperature;
• chest pain, especially when inhaling, shortness of breath;
• weakness, lethargy;
• cough with expectoration of mucus.

Remember, maybe you were hypothermic, had any viral diseases, or were recently treated for bronchitis.

All this may be a confirmation of pneumonia.

During the initial infection with tuberculosis, the process lasts for months until the first symptoms appear. At first it is a slight cough.

Then the symptoms get worse:

• cough with purulent mucus;
• weight loss, lack of appetite;
• sweating at night;
• There is an unhealthy shine in the eyes and a blush on the cheeks.

But there are cases when the disease begins with fever and cough. More research is needed to distinguish tuberculosis from pneumonia. What matters here is whether the patient is at risk.

Laboratory tests are the main method for detecting tuberculosis

When diagnosing lung diseases, one cannot limit oneself to anamnesis and clinical presentation; a number of studies are required:

• Listening to the lungs. In pneumonia and tuberculosis, wheezing has a different character, but even an experienced pulmonologist often cannot distinguish one type of wheezing from another.
• X-ray. With pneumonia, the process is usually in one lung. Tuberculosis most often affects both, less often one. The lesions are more pronounced. Even very good diagnosticians sometimes find it difficult to identify a disease from an image. In addition, inflammatory changes also occur in lung cancer.
• Laboratory blood tests reveal an increase in ESR and leukocytosis in pneumonia. In tuberculosis, leukocytosis is moderate, but there is a drop in hemoglobin to 100.

• Sputum culture. In tuberculosis, mycobacterium is sown. This is the most reliable criterion by which the disease is determined. Unfortunately, sometimes it is necessary to do several sputum cultures, since mycobacteria may not be immediately detected. If the results of the triple analysis did not reveal mycobacteria, then look for another lung disease.
• If tuberculosis is suspected and mycobacteria are not cultured, it is necessary to perform a Mantoux test. Her reaction will tell you what to do next.

These are all the differences that make it possible to calculate the disease. In this case, only laboratory tests can confirm or refute the presence of tuberculosis.

Treatment

Why is it important to correctly identify the disease? Both diseases cannot be eliminated without antibiotics. But if the wrong course of treatment is prescribed, the mycobacterium will become resistant to this type of antibiotic, and the disease will be much more difficult to cure.

Pneumonia is treated with broad-spectrum antibiotics, and the patient's condition improves quite quickly.

The person recovers within two weeks. This is shown by a blood test and x-ray. The photographs show positive dynamics and resorption of foci of inflammation.

If the condition has not improved, it means that something was missed in the diagnosis. In this case, it makes sense to undergo a CT scan.

In most cases it is not difficult to distinguish between the two. In elderly patients, diabetics, patients with chronic renal failure, patients with liver disease, and HIV-infected patients, the clinical features of pneumonia and tuberculosis may be atypical, which makes it difficult to establish a correct diagnosis.

The most common situation to differentiate tuberculosis from pneumonia is when a patient has symptoms of pneumonia but does not respond appropriately to the antibiotics used to treat the disease.

Etiological agents

Pneumonia is an inflammatory disease of the lungs resulting from an infection affecting the alveoli. It is provoked by viral, bacterial infections, fungi, and some autoimmune diseases.

Bacterial pneumonia is caused by the bacteria Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, and infections caused by Haemophilus influenzae are also widespread.

Not provoked by traditional pathogens of a “typical” disease. The pathogens of SARS are Chlamydophila pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, syncytial virus and influenza A virus.

Pneumonia is usually divided into types:

• acquired in the community;
• atypical.

In the first case, the causative pathogens are viruses and gram-positive bacteria; in the latter case, the causative agents of pathogenesis are gram-negative organisms.

Tuberculosis is an infection of the lungs caused by a bacterium of the Mycobacterium species, the most common pathogen is Mycobacterium tuberculosis.

Pneumonia is caused by bacteria, fungi or viruses, while tuberculosis has a single pathogen - Mycobacterium tuberculosis, a bacterium known as Koch's bacillus.

How can they be transmitted?

Tuberculosis and pneumonia have different routes of occurrence and infection. Tuberculosis is an infectious disease that is transmitted through close contact and requires isolation of the patient for some time. Pneumonia is not spread from one person to another, and there is no need to separate an infected patient from his friends and family.

Tuberculosis is an airborne infection transmitted through droplets that occur during or when the patient speaks. For the bacillus to be transmitted to another person, close contact is required. Families and people working in the same environment are high-risk contacts.

Pneumonia is caused by bacteria present in the oropharynx. In normal situations, the respiratory tract's immune system neutralizes these bacteria, keeping germs clear of the lungs. However, the defense system fails when:

• decreased immunity;
• smoking;
• stress;
• insufficient sleep;
• the presence of other diseases;
• contact with more virulent bacteria.

In these cases, the bacteria lead to the development of an infection in the lungs.

The occurrence and course of diseases

It is possible to distinguish tuberculosis from pneumonia by the temporal evolution of both. Pneumonia is an acute, rapidly progressing infection. After a few hours, the patient's condition worsens and he feels the need to seek medical help.

The interval between the onset of the first symptoms and the need for medical care ranges from 48 to 72 hours. Sometimes it is preceded by a cold. The patient has a cold, and a few days after diagnosis there is a sudden regression with a deterioration in the general condition, the appearance of shortness of breath and cough with expectoration.

The development of tuberculosis is different from the development of pneumonia. Its symptoms appear slowly and gradually. The patient experiences and progresses weight loss and poor general condition. The increase in body temperature is insignificant, usually it stays around 37-38 degrees, but can gradually increase. The cough gets worse over time. A week or more may pass before the patient decides to seek medical help.

Signals and symptoms

The most common symptoms of pneumonia are:

• temperature above 38.5 °C;
• cough with yellow or greenish sputum;
• , especially when breathing deeply;
• fatigue;
• chills;
• dyspnea.

The patient is in a state of deterioration in general health, tachycardia and tachypnea (rapid shallow breathing). When listening to the patient with a stethoscope, various clicks and bronchial breathing are heard.

The temperature for tuberculosis is usually moderate, between 37.5 °C and 38.5 °C, mainly in the evening. Night sweats and chills are common. The patient has progressive fatigue, loss of appetite and weight. Nonproductive cough is common. After several days of illness, blood appears in the sputum.

Symptoms of tuberculosis:

• fast and frequent breathing;
• chronic cough;
• not very high temperature;
• hemoptysis;
• weakness and progressive fatigue.

The upper lobe and lower part of the lungs are equally likely to become infected. Tuberculosis is an infectious disease that spreads faster than pneumonia through sneezing and coughing. Risk factors for tuberculosis include malnutrition, smoking, silicosis and the use of drugs such as infiximab and corticosteroids.

X-ray research methods

In pneumonia, chest X-rays show infiltrates (X-ray shadows) or condensation. The typical appearance is a homogeneous or heterogeneous white patch on the affected lung or middle third lobe. Pleural effusion (accumulation of fluid in the pleural space) on the same side of the lung is common. X-ray shadows have unclear boundaries and can be round, irregular, spindle-shaped, or ring-shaped.

Tuberculosis often causes cavitation (cavity formation) in the apex of the lung, which produces a rounded image with air inside. Pleural effusion may also be detected. Infiltrates on x-rays with a pronounced pattern. There are clinical forms:

• disseminated (many small foci);
• focal (one or several shadows of a round or oval shape);
• (darkening of several lobes or the entire lung);
• cavernous (focal darkening of the lung with a lumen in the center).

Lab tests

If the clinical picture does not immediately make it possible to make a correct diagnosis, then laboratory methods, such as microscopic and microbiological tests, can accurately distinguish tuberculosis from pneumonia.

A general blood test in both cases shows an increase in the erythrocyte sedimentation rate. Pneumonia is characterized by a significant increase in the number of leukocytes, while in tuberculosis they are moderately expressed, the level of monocytes is increased, and the level of lymphocytes is decreased.

If pulmonary tuberculosis is suspected, morning sputum is collected three times for microscopic examination.

Using transbronchial puncture biopsy of the lungs, material is obtained for microbiological and histological studies.

Tuberculosis can be active or latent. The active form is detected through amplification tests, while latent tuberculosis is detected through the Mantoux tuberculin test.

Treatment

Tuberculosis and forms of pneumonia require different durations of treatment. If pneumonia is left untreated, bacteria can gain access to the blood vessels and lead to a form of septicemia (blood poisoning) called bacteremia.

Pneumonia when treated with appropriate antibiotics shows signs of improvement within the first 48 hours. Some patients experience improvement after 24 hours. Treatment lasts 8 days, and after 3 to 4 days the patient is free of symptoms.

Tuberculosis is an infection that takes longer to treat. It takes several days to feel better, and the fever disappears after 15 days. Recovery is slow, treatment time is at least 6 months.

Conclusion

Tuberculosis is a contagious disease caused by bacteria that affects the lungs as well as other organs. Pneumonia is a disease caused by a virus, bacteria or fungi that affects only the lungs and is much less contagious.

Answers:

Vasily Ushakov

By virus sticks.

Irima

fluorography. . sputum analysis...

Olga Mironova

Pneumonia can be caused by various bacteria, even bacteria from the bronchial microflora. Tuberculosis is caused by Mycobacterium tuberculosis. The doctor will definitely not confuse you. Fluorography will show. Sputum analysis. In tuberculosis, hemoptysis is allowed.

Alexey Mikhailovich

Sometimes it’s very, very difficult. A sputum test on VK may not show anything at all, even if you do it 30 times! The absence of a VK does not mean anything, but its presence says a lot. Sputum NV VK is sown for three months!! ! During this time you can die.
Localization of the process - TVS usually affects the apexes of the lungs. This should always be alarming in case of pneumonia. If there is no good x-ray positive dynamics on the 14th day from the start of the course of antibacterial therapy, then consult a phthisiatrician, and, if necessary, bronchoscopy, tomogram of the lungs and some other research methods. Only a phthisiatrician can decide on transfer to a TVS hospital, but he is also not the Lord God or a psychic.
A clinical blood test was previously very relevant, but now such “evil” and atypical, rapidly developing forms of TVS have appeared, it may not show anything. A shift of the formula to the right was characteristic of TVS, and to the left - for pneumonia. The tumor also needs to be taken into account and should not be discounted. Now the blood formula doesn’t say anything...

In short, this is a complex matter, and tuberculosis is very dangerous!! ! Not only is it transmitted and it is impossible to completely disinfect the room (for 40-50 years the room where a patient with an open form of tuberculosis was being treated can be dangerous!), but now it proceeds quickly and it is easy to die from it! Other forms of it are resistant to medications!
Therefore, at the slightest suspicion, an urgent examination and consultation is necessary. phthisiatrician! Sometimes, to verify the diagnosis, they do bronchoscopy, bronchial lavage (such as lavage) and directly look for Mycobacterium tuberculosis in this discharge.

What is pulmonary tuberculosis: differential diagnosis and clinical picture

Often in medical practice pulmonary tuberculosis is detected, differential diagnosis of which should be carried out with various diseases (pneumonia, atelectasis, sarcoidosis). Currently, pulmonary tuberculosis is one of the biggest problems. The thing is that about 2 billion people are infected with Mycobacterium tuberculosis. This disease has enormous social significance due to the difficulty of treatment, the possibility of an aerosol transmission mechanism, as well as a high mortality rate. What are the etiology, clinical picture, differential diagnosis and treatment of pulmonary tuberculosis infection?

Characteristics of pulmonary tuberculosis

Tuberculosis is a chronic disease caused by mycobacteria, which can affect various organs, including the lungs. Pulmonary tuberculosis most often occurs in adults. The causative agent of this infection is very resistant to the environment. Due to their structure, mycobacteria have become highly resistant to many modern anti-tuberculosis drugs. The infectious agent is transmitted by the following mechanisms:

• aerosol;
• fecal-oral;
• contact;
• vertical.

The transmission of mycobacteria through the air through coughing is of greatest importance. The airborne route is relevant only in the presence of an active form of the disease, when bacteria are found in sputum and can be released into the environment. The vertical mechanism is rare. The risk group among those infected includes people aged 20 to 40 years. Risk factors are:

• overcrowding of teams;
• close contact with a sick person;
• sharing utensils with the patient;
• decreased immunity;
• presence of HIV infection;
• drug use;
• presence of chronic alcoholism;
• the presence of chronic lung pathology;
• general exhaustion of the body;
• malnutrition (lack of vitamins);
• a history of diabetes mellitus;
• unfavorable living conditions;
• stay in places of deprivation of liberty.

Clinical symptoms

The clinical manifestations of pulmonary tuberculosis are quite varied. They are determined by the form of the disease. The most common symptoms are:

• increased body temperature;
• increased sweating at night;
• decreased appetite;
• weight loss;
• weakness;
• decreased performance;
• dyspnea;
• chest pain;
• cough;
• hemoptysis;
• enlarged lymph nodes.

Knowing these signs is necessary for a correct diagnosis. Differential diagnosis is often based on the symptoms of the disease, and not just the results of laboratory and instrumental studies. The most common complaint of patients in this situation is cough. With pulmonary tuberculosis, it is first dry, then with sputum. The patient may cough for several minutes without stopping. Often when you cough, purulent sputum is released. The cough is often accompanied by shortness of breath and chest pain. In addition to coughing, hemoptysis may occur.

Diagnostic measures

Today, the diagnosis of pulmonary tuberculosis involves:

• conducting a tuberculin test;
• Diaskin test;
• microbiological examination of sputum or biopsy;
• performing chest x-rays;
• general blood and urine tests.

The Mantoux test allows you to assess the state of immunity and determine infection. The test result can be negative, positive or doubtful. A negative result indicates the absence of disease. An important place is occupied by differential diagnosis. To clarify the diagnosis, differential diagnosis is carried out with the following diseases: lobar pneumonia, eosinophilic pulmonary infiltrate, actinomycosis, atelectasis, lung cancer, infarction.

Differential diagnosis

Each form of tuberculosis has its own characteristics. The following types of pulmonary tuberculosis are distinguished: primary, miliary, disseminated, infiltrative, tuberculoma. Clinical forms also include caseous pneumonia. Infiltrative pulmonary tuberculosis is very often detected. At the same time, areas of compaction form in the lung tissues. The infiltrate can occupy an area of ​​several segments or lobes of the organ. It can be very difficult to distinguish from nonspecific pneumonia. The first difference is that with pneumonia the severity of inflammatory processes is much less, while upon physical examination (listening to the lungs) severe symptoms are noted. With infiltrative tuberculosis, on the contrary, changes in tissues prevail over the results of physical examination.

Secondly, with tuberculosis and nonspecific pneumonia, different segments of the lung are affected. With tuberculosis, segments 1, 2 and 6 most often suffer, with pneumonia – 3, 4, 5, 7, 9, 10. Thirdly, anamnesis data are important. With pneumonia, there are often indications of hypothermia or pathology of the upper respiratory tract. Infiltrative tuberculosis can also be recognized clinically. It does not occur as acutely as pneumonia. Cough with tuberculosis is not as frequent, but longer lasting. Intoxication is more pronounced with pneumonia. The temperature rises slightly. With pneumonia it can reach 40 degrees. Fourthly, there are differences in the x-ray picture.

With infiltrative tuberculosis, a heterogeneous shadow, cavities with decay, calcifications, a Gohn's lesion and petrification in the area of ​​the roots of the lungs are found. The Mantoux test for pneumonia is often false positive. Histological examination is of great value. In pneumonia, neutrophils and macrophages are detected, while in tuberculosis, epithelial cells, lymphocytes, and Pirogov-Langhans cells are detected.

The most valuable distinguishing feature of tuberculosis is the presence of Mycobacterium tuberculosis in the sputum.

Tuberculosis and other diseases

In some cases, tuberculosis infection can be mistaken for an eosinophilic infiltrate. This condition is associated with exposure to an allergen. Unlike pulmonary tuberculosis, it is characterized by:

• an increase in eosinophils in the blood;
• rapid regression;
• the presence of darkening with unclear contours, which can be localized in any part of the lung.

A course similar to tuberculosis is observed with actinomycosis, the main symptom of which is chest pain. In the sputum of this disease, structural elements (drusen) of actinomycetes are detected. With actinomycosis, subcutaneous infiltrates or fistulas often form. Differential diagnosis can be made with atelectasis. The latter is characterized by collapse of the lung tissue. Unlike tuberculosis, with atelectasis the main symptoms are shortness of breath, difficulty breathing, and cyanosis. An x-ray shows a decrease in the volume of the affected segment of the lung or an entire lobe. The shadow is uniform and has clear contours. In addition, there is a displacement of healthy tissue towards the lesion.

Difference between caseous and lobar pneumonia

Caseous pneumonia is one of the clinical forms of tuberculosis. It is characterized by cheesy inflammation of the lung tissue. It is often a complication of fibrous-cavernous tuberculosis. It is necessary to be able to distinguish it from focal (lobar) pneumonia. Firstly, sputum in lobar pneumonia is rusty in color, while in caseous pneumonia it is mucopurulent. Secondly, with lobar pneumonia, auscultatory signs are more pronounced. Thirdly, during laboratory testing, lobar pneumonia is indicated by the detection of pneumococci. Urobilin, casts, and protein are found in the urine. In case of caseous pneumonia, mycobacteria are persistently detected.

Fourthly, during X-ray examination, lobar pneumonia most often affects 1 lung. In this case, the lower lobe is affected, whereas with caseous pneumonia, the upper lobe of the lung is involved in the process. After the correct diagnosis is made, treatment is carried out. For this purpose, anti-tuberculosis drugs are used. The first row includes Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin. Thus, tuberculosis has a number of distinctive features that make it possible to exclude other lung diseases.

Symptoms of tuberculosis

The clinical symptoms of pulmonary tuberculosis are varied, but the disease has no specific signs. This is especially important to consider in modern conditions, characterized by unfavorable environmental conditions, frequent use of various vaccines, serums and antibiotics, as well as changes in the properties of the tuberculosis pathogen.

In this case, three circumstances must be kept in mind:

• patients with tuberculosis, when symptoms of the disease appear, turn to a general practitioner, therapist, pulmonologist, infectious disease specialist, neurologist, and less often - to other medical workers, and not to a phthisiatrician,
• tuberculosis is an infectious disease, and patients can pose a serious danger to others;
• Treatment of patients with tuberculosis requires the use of specific anti-tuberculosis drugs and should be carried out under the supervision of a TB specialist who has the necessary knowledge and skills.

Questioning and physical examination only allow one to suspect tuberculosis. To timely clarify the diagnosis, special research methods are required: immunological, microbiological, radiation, endoscopic and morphological. They are crucial in the diagnosis and differential diagnosis of tuberculosis, assessing the course of the disease and treatment results.

Study of complaints and anamnesis

When getting acquainted with the medical history, it is necessary to establish when and how the disease tuberculosis was detected: when visiting a doctor about any complaints or during an examination (preventive or for another disease). The patient is asked about the time of onset of symptoms and their dynamics, previous illnesses, injuries, and operations. Pay attention to such possible symptoms of tuberculosis as pleurisy and lymphadenitis, identify concomitant diseases: diabetes mellitus, silicosis, gastric and duodenal ulcers, alcoholism, drug addiction, HIV infection, chronic obstructive pulmonary disease (COPD), bronchial asthma. They clarify whether he received drugs that suppress cellular immunity (glucocorticosteroids, cytostatics, antibodies to tumor necrosis factor).

Important information is about staying in regions with a high incidence of tuberculosis, in institutions of the penitentiary system, about participation in military operations, the place and living conditions of the patient, about the presence of children in the family. What matters is the profession and nature of the work, material and living conditions, lifestyle, and the presence of bad habits (smoking, drinking alcohol, drugs). Assess the patient's level of culture. Parents of sick children and adolescents are asked about anti-tuberculosis vaccinations and the results of tuberculin tests. It is also necessary to obtain information about the health of family members, possible contact with tuberculosis patients and its duration, and the presence of animals with tuberculosis.

When identifying contact with a patient with tuberculosis, it is important to clarify (request at another treatment and prevention institution) the form of the disease, bacterial excretion, the presence of mycobacteria resistance to anti-tuberculosis drugs, the treatment performed and its success.

Typical symptoms of respiratory tuberculosis: weakness, increased fatigue, loss of appetite, weight loss, increased body temperature, sweating. cough, shortness of breath, chest pain, hemoptysis. The severity of tuberculosis symptoms varies, and they occur in various combinations.

Early manifestations of tuberculosis intoxication may include symptoms of tuberculosis such as weakness, increased fatigue, loss of appetite, weight loss, irritability, and decreased performance. Patients often do not associate these symptoms of tuberculosis with the disease, believing that their appearance is due to excessive physical or mental stress. Symptoms of tuberculosis and intoxication require increased attention, especially in individuals at risk for tuberculosis. With an in-depth examination of such patients, initial forms of tuberculosis can be identified.

Increased body temperature (fever) is a typical clinical symptom of infectious and many non-infectious diseases.

With tuberculosis, body temperature can be normal, subfebrile and febrile. It is often characterized by significant lability and can increase after physical or mental stress. Patients usually tolerate an increase in body temperature quite easily and often hardly feel it.

With tuberculosis intoxication in children, body temperature rises in the afternoon for a short time to 37.3-37.5 ° C. Such rises are observed periodically, sometimes no more than twice a week, and alternate with long periods of normal temperature. Less commonly, body temperature remains within 37.0 °C with differences between morning and evening temperatures of approximately one degree.

A persistent low-grade fever with slight temperature fluctuations during the day is not typical for tuberculosis and is more common with chronic nonspecific inflammation in the nasopharynx, paranasal sinuses, bile ducts or genitals. An increase in body temperature to low-grade fever can also be caused by endocrine disorders, rheumatism, sarcoidosis, lymphogranulomatosis, and kidney cancer.

Hectic fever is characteristic of acutely progressive and severe tuberculosis lesions (miliary tuberculosis, caseous pneumonia, pleural empyema). Intermittent hectic fever is one of the diagnostic signs that distinguishes the typhoid form of miliary tuberculosis from typhoid fever. Unlike tuberculosis, with typhoid fever the body temperature has a steady tendency to increase, and then remains stably high for a long time.

In rare cases, patients with pulmonary tuberculosis experience a perverted type of fever, when the morning temperature exceeds the evening temperature. Such fever indicates severe intoxication.

Excessive sweating is a common symptom of tuberculosis. Patients with tuberculosis in the early stages of the disease often notice increased sweating on the head and chest at night or in the morning. Severe sweating (symptom of “wet pillow”) in the form of profuse sweat occurs with caseous pneumonia, miliary tuberculosis, other severe and complicated forms of tuberculosis, as well as with nonspecific acute infectious diseases and exacerbations of chronic inflammatory processes.

Cough very often accompanies inflammatory, tumor and other diseases of the lungs, respiratory tract, pleura, and mediastinum.

In the early stages of tuberculosis, there may be no cough; sometimes patients notice periodic coughing. As tuberculosis progresses, the cough intensifies. It can be dry (non-productive) or with sputum (productive). A dry paroxysmal cough appears when the bronchus is compressed by enlarged lymph nodes or displaced mediastinal organs, for example in a patient with exudative pleurisy. Particularly often, a dry paroxysmal cough occurs with bronchial tuberculosis. A productive cough appears in patients with pulmonary tuberculosis due to the destruction of lung tissue, the formation of a lymphobronchial fistula, or a breakthrough of fluid from the pleural cavity into the bronchial tree. Cough with tuberculosis can also be caused by chronic nonspecific bronchitis or bronchiectasis accompanying tuberculosis.

Sputum in patients with early stages of tuberculosis is often absent or its production is associated with concomitant chronic bronchitis. After the collapse of the lung tissue, the amount of sputum increases. In uncomplicated pulmonary tuberculosis, sputum is usually colorless, homogeneous and odorless. The addition of nonspecific inflammation leads to increased coughing and a significant increase in the amount of sputum, which can become purulent.

Dyspnea is a clinical symptom of respiratory or cardiovascular failure. In lung diseases, it is caused by a decrease in the respiratory surface, impaired bronchial obstruction, limited chest excursion, and impaired gas exchange in the alveoli. Of particular importance is the impact on the respiratory center of toxic waste products of pathogenic microorganisms and substances formed during the breakdown of tissues.

Severe shortness of breath - in acute pulmonary tuberculosis, as well as in chronic disseminated, fibrous-cavernous, cirrhotic pulmonary tuberculosis.

The progression of tuberculosis can lead to the development of chronic pulmonary heart disease (CP) and pulmonary heart failure. In these cases, shortness of breath increases noticeably.

The large proportion of smokers among patients with tuberculosis determines the prevalence of concomitant COPD, which can affect the frequency and severity of expiratory dyspnea and requires differential diagnosis.

Dyspnea is often the first and main symptom of such complications of pulmonary tuberculosis as spontaneous pneumothorax, atelectasis of a lobe or the entire lung, or pulmonary embolism. With the rapid accumulation of a significant amount of exudate in the pleural cavity, severe inspiratory dyspnea may suddenly occur.

Chest pain is a symptom of diseases of various organs: trachea, lungs, pleura, heart, aorta, pericardium, chest wall, spine, esophagus, and sometimes abdominal organs.

With pulmonary tuberculosis, chest pain usually occurs due to the spread of the inflammatory process to the parietal pleura and the occurrence of perifocal adhesive pleurisy. Pain occurs and intensifies with breathing, coughing, and sudden movements. The localization of pain usually corresponds to the projection of the affected part of the lung onto the chest wall. However, with inflammation of the diaphragmatic and mediastinal pleura, the pain radiates to the epigastric region and neck. shoulder, heart area. The weakening and disappearance of pain in tuberculosis is possible even without regression of the underlying disease.

With dry tuberculous pleurisy, pain occurs gradually and persists for a long time. It intensifies with coughing and deep breathing, pressing on the chest wall and, depending on the location of the inflammation, can radiate to the epigastric or lumbar region. This makes diagnosis difficult. In patients with exudative tuberculous pleurisy, chest pain occurs acutely, but decreases with the accumulation of exudate and remains dull until it resolves.

In cases of acute pericarditis, which sometimes occurs with tuberculosis, the pain is often dull and intermittent. It decreases in a sitting position when bending forward. After the appearance of pericardial effusion, the pain subsides, but when it disappears, it may recur.

Sudden sharp pain in the chest occurs when tuberculosis is complicated by spontaneous pneumothorax. Unlike pain with angina pectoris and myocardial infarction, pain with pneumothorax intensifies during talking and coughing and does not radiate to the left arm.

With intercostal neuralgia, pain is limited to the area of ​​the intercostal nerve and intensifies with pressure on the area of ​​the intercostal space. Unlike pain with tuberculous pleurisy, it intensifies when the body is tilted to the affected side.

With lung tumors, chest pain is constant and can gradually intensify.

Hemoptysis (pulmonary bleeding) is more often observed with infiltrative, fibrous-cavernous and cirrhotic pulmonary tuberculosis. Usually it gradually stops, and after the release of fresh blood, the patient continues to cough up dark clots for several more days. In cases of aspiration of blood and the development of aspiration pneumonia after hemoptysis, an increase in body temperature is possible.

Hemoptysis is also observed in chronic bronchitis, nonspecific inflammatory, tumor and other diseases of the chest organs. Unlike tuberculosis, patients with pneumonia usually first develop chills and fever, followed by hemoptysis and stabbing pain in the chest. With a pulmonary infarction, chest pain often appears first, followed by fever and hemoptysis. Prolonged hemoptysis is typical for patients with lung cancer.

Massive pulmonary hemorrhages more often occur in patients with fibrocavernous. cirrhotic tuberculosis and gangrene of the lungs.

In general, it should be borne in mind that respiratory tuberculosis often begins as a general infectious disease with symptoms of intoxication and often occurs under the masks of influenza or pneumonia, and with treatment with broad-spectrum antibiotics (especially fluoroquinolones, aminoglycosides, rifampicins), the patient’s condition may improve. The further course of tuberculosis in such patients is usually wave-like: periods of exacerbation of the disease are replaced by periods of relative well-being. In extrapulmonary forms of tuberculosis, along with symptoms caused by tuberculosis intoxication, patients experience local manifestations of the disease. Thus, tuberculous meningitis is characterized by a headache, with laryngeal tuberculosis a sore throat and hoarseness are noted, with osteoarticular tuberculosis - pain in the back or joint, changes and stiffness of gait, with tuberculosis of the female genital organs - pain in the lower abdomen, menstrual irregularities. functions, with tuberculosis of the kidneys, ureters and bladder - pain in the lumbar region, dysuric disorders, with tuberculosis of the mesenteric lymph nodes and intestines - pain in the abdomen and dysfunction of the gastrointestinal tract. However, patients with extrapulmonary forms of tuberculosis, especially in the early stages, do not show any complaints, and the disease is detected only by special research methods.

Physical methods of examination of patients with tuberculosis

Inspection

Not only in medical literature, but also in fiction, the appearance of patients with progressive pulmonary tuberculosis, which is known as habitus phtisicus, is described. Patients are characterized by a lack of body weight, a blush on a pale face, shiny eyes and wide pupils, dystrophic skin changes, a long and narrow chest, widened intercostal spaces, an acute epigastric angle, lagging (pterygoid) shoulder blades. Such external signs are usually observed in patients with late stages of the tuberculosis process. When examining patients with initial manifestations of tuberculosis, sometimes no pathological changes are detected at all. However, an inspection is always necessary. It often reveals various important symptoms of tuberculosis and should be carried out in full.

Pay attention to the physical development of the patient, the color of the skin and mucous membranes. The severity of the supraclavicular and subclavian fossae, the symmetry of the right and left halves of the chest are compared, their mobility during deep breathing, and the participation of auxiliary muscles in the act of breathing are assessed. Narrowing or widening of intercostal spaces, postoperative scars, fistulas or scars after their healing are noted. On the fingers and toes, pay attention to the deformation of the terminal phalanges in the form of drumsticks and changes in the shape of the nails (in the form of watch glasses). In children, adolescents and young adults, scars on the shoulder after BCG vaccination are examined.

Palpation

Palpation allows you to determine the degree of skin moisture, its turgor, and the severity of the subcutaneous fat layer. The cervical, axillary and inguinal lymph nodes are carefully palpated. In inflammatory processes in the lungs involving the pleura, lag of the affected half of the chest during breathing and soreness of the pectoral muscles are often noted. In patients with chronic tuberculosis, atrophy of the muscles of the shoulder girdle and chest may be detected. A significant displacement of the mediastinal organs can be determined by palpation based on the position of the trachea.

Voice tremors in patients with pulmonary tuberculosis can be normal, increased or weakened. It is better performed over areas of compacted lung with infiltrative and cirrhotic tuberculosis, over a large cavity with a wide draining bronchus. A weakening of vocal tremors until it disappears is observed in the presence of air or fluid in the pleural cavity, atelectasis, massive pneumonia with bronchial obstruction.

Percussion

Percussion makes it possible to identify relatively gross changes in the lungs and chest with infiltrative or cirrhotic lesions of a lobar nature, pleural fibrosis. Percussion plays an important role in the diagnosis of such emergency conditions as spontaneous pneumothorax, acute exudative pleurisy, and pulmonary atelectasis. The presence of a box or shortened pulmonary sound allows you to quickly assess the clinical situation and conduct the necessary studies.

Auscultation

Tuberculosis may not be accompanied by changes in breathing patterns and the appearance of additional noise in the lungs. One of the reasons for this is obstruction of the bronchi draining the affected area with dense caseous-necrotic masses.

Decreased breathing is a characteristic sign of pleurisy, pleural adhesions, and pneumothorax. Hard or bronchial breathing can be heard over infiltrated lung tissue, amphoric breathing can be heard over a giant cavity with a wide draining bronchus.

Rattles in the lungs and pleural friction noise often make it possible to diagnose a pathology that is not always detected during X-ray and endoscopic examinations. Fine-bubble moist rales in a limited area are a sign of the predominance of the exudative component in the area of ​​inflammation, and medium- and large-bubble rales are a sign of a cavity or cavity. To listen to moist rales, the patient should be asked to cough after a deep inhalation, exhalation, a short pause, and then a deep breath again. In this case, at the height of deep inspiration, wheezing appears or its number increases. Dry wheezing occurs with bronchitis, wheezing - with bronchitis with bronchospasm. With dry pleurisy, a pleural friction noise is heard, with pericarditis - a pericardial friction noise.

How to quickly detect pneumonia at home?

How to determine pneumonia at home? Pneumonia is a common infectious disease that affects lung tissue. The inflammatory process develops in the alveoli and bronchi, leading to the appearance of pathological changes in them. Pneumonia most often occurs in children, but is often diagnosed in adults. The causative agents of the disease are mycoplasmas, staphylococci and viruses. Depending on the type of microorganisms that have entered the lung tissue, symptoms may vary.

Causes of pneumonia

Pneumonia occurs not only upon contact with pathogenic bacteria and viruses; it can also occur in bedridden patients when pulmonary circulation is impaired. Therefore, it is recommended to turn the patient over frequently. This will help avoid the formation of bedsores that cause blood infections. Treatment takes about a month and includes taking antibiotics, immunomodulators and restorative drugs, as well as physical therapy. Some folk remedies also have a good effect.

The main signs of the disease are: pain in the chest, painful cough with sputum, high fever, increased fatigue, pain in muscles and joints.

If you have at least one of these signs, it is recommended to consult a doctor immediately.

Weakened immunity contributes to the rapid development of the disease, and bad habits aggravate its course: smoking and alcoholism. Inhalation of tobacco smoke contributes to irritation of the mucous membranes of the bronchi. Other reasons for the development of pneumonia are: surgical interventions, chronic heart and vascular diseases, endocrine disorders, poor nutrition, and poor environmental conditions. Pneumonia can be bacterial, viral or atypical. It can be quite difficult to understand exactly what form of the disease a patient has. The signs of pneumonia may not be recognized and may be confused with the symptoms of a cold or acute respiratory viral infection. However, there are also specific signs of how to recognize pneumonia.

How to diagnose pneumonia?

So, let's figure out what to do if you are faced with a disease such as pneumonia, how to determine pneumonia? Clinical manifestations depend on the degree of damage to the lung tissue and the age of the patient. In children and older people, this disease is more severe. One of the characteristic signs of pneumonia is pain when coughing. Rare coughs eventually turn into a painful, debilitating cough. In addition, body temperature rises sharply to 39-40 ° C and is accompanied by fever. Chest and abdominal pain appear when inhaling, sneezing and coughing.

In the following stages of the disease, the patient experiences constant aching pain in the chest, breathing becomes more frequent. The sputum contains impurities of pus and is yellow or brown in color. As the temperature rises, the skin becomes dry and begins to peel. Intoxication develops, which manifests itself in the form of rapid heartbeat and headaches. The body begins to dehydrate.

In addition to the characteristic symptoms of pneumonia, there is a decrease in appetite, the appearance of an unhealthy blush on the cheeks, especially from the inflamed lung. Due to a severe decrease in immunity, stomatitis and rashes on the lips may appear. Urine is released in small quantities and is dark in color.

In order to avoid serious complications, it is necessary to undergo examination and begin treatment immediately. Focal forms of the disease affect individual lobes of the lung and can occur without pronounced symptoms. Under the influence of certain factors, focal inflammation can worsen and quickly take over the entire lung.

How to treat pneumonia on an outpatient basis? Correct treatment of pneumonia will require complex therapy. The course of treatment is selected individually, depending on the causative agent of the disease and the main symptoms. Usually several drugs that are compatible with each other are prescribed. Only a doctor can select them, and in some cases the course of treatment needs to be adjusted.

Why take antibiotics?

Focal pneumonia, previously considered a fatal disease, is completely curable with the help of modern antibiotics. The main task of doctors is to select an effective antibiotic. Many infectious agents become resistant to certain antibiotics over time, especially if they are taken incorrectly.

Before starting therapy, it is necessary to take sputum for analysis. Sowing on nutrient media will help identify the causative agent of infection and select an antibacterial drug.

Mild forms of pneumonia occur when mycoplasma, chlamydia and pneumococci enter the body. These pneumonias have their own characteristics, with the help of which doctors distinguish them from other forms of pneumonia. For pneumococcal infections, penicillin antibiotics are prescribed. If the disease is caused by mycoplasmas, tetracycline antibiotics, fluoroquinolones and macrolides will be effective. Macrolides and fluoroquinolones are suitable for killing chlamydia. The length of treatment depends on how quickly symptoms begin to subside. It is recommended to take antibiotics for at least a week.

How to remove phlegm?

An important part of treatment is removing mucus from the lungs. The accumulation of sputum in the lungs promotes the proliferation of bacteria and aggravates the course of the disease. Nowadays, ambroxol is most often prescribed for the treatment of pneumonia. This drug thins sputum without increasing its volume, activates bronchial peristalsis, which promotes rapid removal of sputum from the bronchi, and stimulates the production of surfactant, a substance that prevents the walls of the alveoli from sticking together. Thanks to these properties, this drug can replace most mucolytics and antitussives. It can be administered by inhalation or in the form of tablets and syrups.

Warming and physiotherapeutic methods of treatment have a good effect on pneumonia. They can be prescribed after the body temperature has dropped. At home, you can install jars and mustard plasters, carrying out these procedures alternately. Then they move on to procedures performed in the clinic. For pneumonia, UHF, electrophoresis with drugs, magnetic therapy, etc. are prescribed. During the recovery period, you can undergo paraffin therapy and mud therapy. Breathing exercises begin immediately after the body temperature has returned to normal.

Traditional methods of treating pneumonia

Taking antibiotics can be combined with the use of the following drugs:

1. 1 tbsp. a spoonful of St. John's wort and 3 tbsp. spoons of elecampane pour 0.5 liters. boiling water Boil the broth over low heat for 30-40 minutes. Melt 2 cups of linden honey in a water bath. Add 1 cup of vegetable oil to liquid honey. Then strain the decoction of St. John's wort and elecampane and add the resulting mixture of honey and oil to it. Infuse the medicine in the refrigerator for 2 weeks in a glass container, then take 1 teaspoon 5 times a day. The course of treatment is 2 weeks.
2. Finely chop 250 g of aloe leaves and mix with 0.5 l. Cahors and 350 g of liquid honey. Leave for 2 weeks, strain and take 1 tbsp. spoon 3 times a day.

Patient rehabilitation