Methods of early diagnosis of tuberculosis with laboratory tests. Early Introduction Tuberculosis Ji Expert Analysis on Tuberculosis

Tuberculosis is one of the most common human and animal diseases in the world and continues to remain the main cause of death among all infectious diseases. They fall into the human body in childhood and, subsequent, this meeting always ends with damage to its integrity.

The diagnosis of tuberculosis is based on the detection of pathogens in biological material and specific changes in the affected organs of the patient. Timely detection of tuberculosis allows you to heal the patient as soon as possible with minimal damage for its health and ensures the cessation of infection with the pathogens of others.

At the first meeting with the patient, the doctor reveals the patient's complaints, polls him in order to obtain information about the development of the disease and life, examines the patient, uses physical examination methods.

Properly assembled history - the guarantee of diagnosis in the shortest possible time and began adequate treatment.

Detection and diagnosis of tuberculosis using bacteriological methods

What material is subject to testing on tuberculosis

With suspicion of tuberculosis of respiratory organs For analysis, the sputum is taken and the material collected under the bronchological examination.

The range of sputum is carried out when treating a patient to a doctor with complaints, suspicious on tuberculosis. It is assembled at least 3 portions of sputum.

Material for microbiological research is the washing water of the stomach in children with and bronchi, since young children are wetted, and swallow.

Fig. 1. In the photo room for collecting sputum.

When localizing the process in any other organ Materials for testing for tuberculosis can be the most diverse liquid mediums of the body: the spinal fluid, a liquid from the pleural cavity, a joint cavity, a liquid from the abdominal cavity, blood and separated from the RAS and fistula.

The material for testing on tuberculosis can be pieces of fabric of the affected organ obtained during biopsy and during operational intervention, during punctures of lymph nodes and scraps, a bone marrow point.

Fig. 2. In the photo on the left - pleural puncture, right - puncture of the spinal cord.

With suspicion of tuberculosis of urinary and sexual systems For a microbiological research takes urine collected in the morning (after night sleep). The best option is the assembled average portion of the morning urine. Sterile dishes are used to collect analysis. Before collecting urine, a careful toilet of external genital organs is carried out.

Fig. 3. The analysis is collected by the average portion of morning urine.

With suspected tuberculosis of female genital organs Menstrual blood is taken to carry out a microbiological study, assembled with the cap of the kafki.

Types of bacteriological research

Bacterioscopic research

Analysis on tuberculosis by direct bacterioscopy is the easiest and faster method of detecting mycobacteria in the material under study. You can identify the presence of the causative agent for 1st hour. When using this method, the detection of mycobacteria is possible only under the condition of their content of at least 10 thousand microbial bodies in 1 ml of material. Therefore, the negative result still does not serve as a basis for excluding the diagnosis of tuberculosis. In addition, the quality of the diagnostic material is influenced by the performance of the analysis.

Fig. 4. To identify mycobacterium tuberculosis in sputum and other biological material, a technique is used to identify the pathogen in the smear - direct bacterioscopy (left) and fluorescent microscopy (right).

Cultural method

Analysis on tuberculosis by sowing biological material (culture method) is more sensitive than microscopy smear. MBT is detected if there are several hundred in the material under study. The time of receipt of the answer from 3 weeks to 3 months. Prior to this period, chemotherapy is assigned "blindly".

Fig. 5. To detect mycobacterium tuberculosis in sputum and other biological material, a technique is used to identify the pathogen during the crops of the material to the nutrient media. On the photo on the left, the growth of the colonies of mycobacteria on the Egg medium of Lévenztein-Jensen is visible. In the photo on the right colony of mycobacteria.

PCR method (polymerase chain reaction)

Diagnosis of tuberculosis using the PCR technique is the most promising in modern conditions. The high sensitivity of the test makes it possible to identify the DNA of MBT in various biological materials, which is particularly important in the diagnosis of extralegal. Mycobacteria is detected if there are several dozen in the material under study. This diagnostic method does not replace the culture method.

Automated system of cultivation of mycobacterium

Application of automated cultivation systems mycobacteria Mgit-Bactec-960 and MB / BACT. Significantly reduces the time to identify the growth of mycobacteria, which averages 11-19 days. However, the high cost of complex equipment and the requirement of the availability of qualified personnel eliminates the current implementation of this method of diagnosis in the Russian Federation.

Sensitivity of tuberculosis diagnostics:

• PCR - 75%,
• BACTEC - 55.8%,
• cultural method - 48.9%,
• microscopy - 34%.

The average detection time of MBT with different methods of tuberculosis diagnostics:

• sowing - 24 days,
• Vastez - up to 14 days,
• PCR - 1 day.

Fig. 6. In the photo on the left, the automated BACTEC MGIT system using a liquid nutrient medium to isolate tuberculosis sticks. In the photo on the right, the growth of mycobacteria on the liquid medium (bouillon culture). The arrows indicate the colonies of pathogens.

Diagnosis of tuberculosis using other techniques

Rady diagnosis of tuberculosis

The methods of radiation diagnosis of tuberculosis significantly enriched knowledge of general practitioners and phthisiators in relation to the identification, manifestations and flow of various forms of the disease. These include fluorography, radiography, various types of tomography.

Fig. 7. On the photo on the left, the fluorograph is a digital low-grade stationary FSC-Rentheh and the X-ray diagnostic stationary television-controlled right.

Fig. 8. In the photo, X-ray devices are mobile (celades) digital.

Fig. 9. In the photo, computer tomographs.

Bronchological methods of diagnosis of tuberculosis

The use of bronchoscopy allows you to inspect trachea and bronchi with a fence of diagnostic material under anesthesia (RBS) and without anesthesia (FBS), as well as carry out therapeutic procedures.

Fig. 10. In the photo bronchoscope (left). Conducting bronchoscopy - right.

Fig. 11. On the photo on the left, ulcerative tuberculosis of the right main bronchus, which developed due to a breakthrough in the armor of caseometric masses from the affected intragenic lymph nodes (the fistula is indicated by the arrow). Right - pulmonary bleeding.

Study of the function of external respiration in the diagnosis of tuberculosis

Spirometry is an integral part of a comprehensive clinical study. With it, it is diagnosed with violations of the ventilation function of the lungs, the type and severity of violations is detected, evaluating the effectiveness of the therapy.

Fig. 12. In the photo conducting a study of the function of external respiration.

NEAL METHODS OF RESEARCH IN DIAGNOSTICS OF TUBERCULES

The puncture of the pleural cavity and the transducer needle aspiration biopsy is widely used in phthisiatry. The study of the resulting pathological material helps to establish or refine the diagnosis.

Fig. 13. In the photo, the puncture of the chest in order to obtain the cellular material from the pulmonary fabric.

Open diagnostic operations as a method for diagnosing tuberculosis

Open diagnostic operations are carried out in the case when other methods of diagnosis of tuberculosis proved to be minor informative. The biopsy of lymph nodes is most often carried out. Less frequently - diagnostic thoracotomy (opening of the thoracic cavity) with a biopsy of a lung fabric and pleura.

Fig. 14. On the photo open biopsy of lymph nodes (left) and thoracotomy (left).

Endosurgery operations in the diagnosis of tuberculosis

Open endosurgical operations are carried out in the case when other methods of diagnosis of tuberculosis were minor informative. Plugs or small incisions of the chest followed by the introduction of optical devices. The study of the pleural cavity (pleuroscopy) and the mediastinum (mediastinoscopy) with the fence of the diagnostic material is widely used in phthisiology.

Fig. 15. In the photo on the left of the thoracoscopy, with the subsequent biopsy of the mediastinal lymph node. Right - Transbronchial Lung Biopsy.

Timely detection of patients with tuberculosis - the main measure of the prevention of the disease

Timely detection of tuberculosis will allow to heal the patient as soon as possible with minimal damage to the health of the patient. The late detection of the disease, when the vast plots of the organ with the presence of degradation foci and massive bacillos, are heavier, and sometimes impossible. Such patients are particularly dangerous for their population.

Tasks for identifying patients with tuberculosis are assigned to the doctors of the general treatment network. To identify the disease is prescribed in preventive inspections, in patients who applied for medical care to the clinic and in patients who are inpatient treatment about other diseases. Doctors of the general medical network are obliged to know, correctly interview and inspect patients, examine with the use of radiation methods of diagnosis, microbiological and bronchological.

Mass fluorographic examinations of adult and adolescent population are used in the Russian Federation for early, timely detection of tuberculosis. Tuberculinidiagnosis is the main method of identifying infected by mycobacteriums with elevated risk of disease and patients. For tuberculinidiagnosis, the Mantu reaction is applied (). It is the only method of early detection of the disease in children.

The timely detection of the disease and adequate treatment leads to the fact that patients quickly become unsuccessful and finally cured in the time limit.

Fig. 16. The reaction of manta (manta sample) is the only method of early detection of tuberculosis in children.

Fig. 17. To identify the disease in mass order, moving (right) and stationary (left) fluorographic installations are used.

Timely identification and diagnosis of tuberculosis, adequate intensive treatment will help reduce the number of tuberculosis infected and prevent the emergence of new cases of the disease.

Articles section "Tuberculosis"Most popular

Tuberculosis is distinguished by the manifestation of manifestations and forms, due to which its diagnosis is complicated. However, timely detection of the disease is of particular importance. From this depends the complexity of treatment, as well as the outcome. If you diagnose the disease at an early stage of development, there is more likelihood of salvation of the patient's life. Diagnosis consists of several main stages: detection of symptoms, examination of the patient, conducting special research.

At the first stage, when the patient only applied for medical care, the doctor should detect signs of the disease. The clinical manifestations of tuberculosis include a protracted cough, hemoptia, an increase in body temperature, sweating, increased fatigue and reduced performance. It is important for these symptoms to draw attention, as they indicate the possible development of alend. In addition, at this stage, it is necessary to find out the characteristics of the evolution of the disease. The doctor asks the patient about whether he had contact with people who had a diagnosis of Tuberculosis.

Inspection of the patient

With a clinical inspection of the patient, the doctor pays particular attention to weight loss, checks the lymph nodes, violating the amplitude of the chest movement during breathing. Of course, the first methods for identifying tuberculosis are not fully reliable. To make sure the development of the disease is necessary to conduct other tests. But it is these two stages that determine the need to send a patient for a special examination. It is already possible to approximately create a clinical picture and put forward an assumption about the presence of an ailment.

Special research

If during the patient examination at the first two stages, suspicion of tuberculosis arose, to set the exact diagnosis, a number of studies will be required. In adult tuberculosis examination provides for the mandatory passage of x-ray diagnosis. By its pictures, it is possible to determine the presence of foci of lesion in the lungs. If they are present, the patient is directed to an additional examination, which will reveal the form of the disease, the stability of the infection to antibacterial drugs. Then he is prescribed treatment.

The diagnosis of tuberculosis in children involves the conduct of the Mantu sample. By its reaction, you can determine the presence of ailment. Although, and this method is not fully reliable. The reaction may be false positive or false negative. If, after testing Mantu, the doctors remained suspicion of the development of infection in the children's body, they are re-made. If she confirms the presence of a pathological process, a child is sent to additional research into a tubdy scan.

These methods for diagnosing tuberculosis are intermediate. On them you can already make some conclusions, but it is impossible to establish an accurate diagnosis. To finally ensure the presence of the disease, you will need to hold another study. It belongs to the laboratory diagnosis of tuberculosis: analyzes of mocry, blood, urine.

X-ray study

The most accurate diagnostic method in adults is the detection of tuberculosis with a radiographic study. In the case of the development of the pathological process, seals and dimming will be noticeable in the pictures. As for the shadows, special attention should be paid to their quantity, magnitude, shape, contours, intensity, structure, localization. In addition, importance is a change in the pulmonary pattern. Shadows can merge or have clear contours.

The following degrees of lesion can be determined on radiological images:

• minimal (small lesions, signs of decay are absent);
• moderately pronounced (small changes occur, which in terms of volume do not exceed one lung);
• pronounced (the volume of lesions is large).

Sample mantu

The identification of tuberculosis, as a rule, in children, occurs with the help of a mantu sample. Its essence lies in the fact that the antigens of the pathogen are introduced under the skin. Thus, the test of manta causes a reaction if tuberculosis infection is present in the body. In this case, the injection place swells, blushes and inflates.

Tuberculin, which is introduced under the skin when testing manta, is obtained from destroyed koche sticks.

They are the causative agent of tuberculosis. Manta test is usually done in the forearm. The body recognizes tuberculin as an infection. In the case when immunity is familiar with it, the focus of inflammation appears on the spot.

Another option is the sample pirch. Its essence consists in the cake of tuberculin. This substance itself is safe, therefore it is not capable of harming a person. But tuberculin is characterized by high allergenity, due to which the corresponding reactions can cause.

Before the result of the Mantu sample is estimated, it is forbidden to influence the place of injury. Thus, it can not be wetted, scratching, as well as lubricate with greenflaw, iodine and other antiseptic drugs. It is not recommended to apply adhesive plaster and dressings that some parents practiced so that the child does not touch the injection site. All this may adversely affect the results and lead to the installation of inaccurate diagnosis.

Contraindications for mantu

Despite the harmlessness of the sample Mantu, in some cases it is not recommended to do it. Contraindications concern those people who suffer from skin diseases. In this case, the injection may worsen the dermal disease, lead to its exacerbation. Do not use this method of diagnosis in the presence of infectious diseases in acute and chronic form. It is allowed to test a month after recovery. Contraindications are fever and various allergic reactions, as well as epilepsy.

In order to avoid unreliability when conducting Mantu, it is recommended not to put it in one day with vaccinations. Moreover, it concerns any vaccination. In the case when the vaccinations were still made before the introduction of tuberculin, you should not expect results quickly. Most likely, they will be obtained only six weeks. It is still worth saying a few words about the main thing. Some parents mistakenly assume that the sample with the subcutaneous administration of tuberculin ensures the protection of the body from tuberculosis, producing immunity. Such an approval is rooted incorrectly. The sample is only a study method for the presence of this disease. In no case will it be replaced by the BCG vaccine.

Collection of sputum

Laboratory diagnostics of tuberculosis includes the analysis of sputum, which is separated during the cough. The quality of the result largely depends on the compliance with the rules when collecting. There are several of them:

• the sputum needs to be collected into a sterile container issued by a doctor specifically for these purposes;
• before collecting, it is recommended to rinse the oral cavity with warm water, clean the teeth (food particles should not get into the wet);
• the collection is performed on an empty stomach, be sure to in the morning, since it is at this time its cluster maximum;
• the container should be made by the sputum, and not saliva (it is possible to determine the content by consistency and color);

When the main preparations are completed, you can proceed to the process itself. First, two deep exhalations are performed with breathing delay. After that, you should take a deep breath and exhale air with force. Then it is worth sighing again and flip. Then the container is presented to the mouth and the sputum is spoiled into it. Capacity should be immediately closed with a lid. If the contents during the cough did not separate, you should knock on the chest fist. Another option is inhalations over hot water, which added a spoonful of food soda.

Survey study

First, sowing sputum is closely considered. If a person is sick with tuberculosis, he may have blood streaks in the mucus separated by coughing. Then a bacterioscopic study is carried out - painted seeding is considered under the microscope. In the smears, you can determine the presence of infection in the body in adults and children. Sowing may contain elastic or coral fibers, lime particles. To identify mycobacterium tuberculosis, the sputum is subjected to a repeated study. Sometimes X-ray examination does not show pathological processes occurring in the lungs, and sowing indicates their presence.

The essence of the bacteriological method is that the material of the material under study is carried out on the nutrient media. Before that, the sputum is processed to prevent the growth of nonspecific microflora. Sowing is performed on a solid, liquid or semi-liquid nutrient medium. Sometimes mycobacteria, which are determined during this analysis, do not grow under such conditions. The reason for this is loss of ability to reproduce, which happened under the influence of drugs.

In addition, the biological method of studying the sputum on tuberculosis is used - its essence is an infection of animals to the mucous contents of light patient. For this, guinea pigs are usually used, which express high sensitivity to mycobacteriums of this disease.

More recently, the bacteriological method was considered the most reliable, but scientists found that mycobacteria tuberculosis, which are contained in sputum sowing, are able to grow on nutrient media, but not to affect animals. It's all about the loss of infection ability. Thus, it is recommended to investigate sowing several methods to obtain a reliable result.

Bronchoscopy.

If the collection of sputum does not work independently, bronchoscopy is used. The essence of the method is to use a special device called a bronchoscope, which through the mouth or the nasal cavity gets into bronchi. Such a study is carried out on an empty stomach. This avoids the fall of food particles into the respiratory tract, if there is a cough or vomit.

Before conducting research, the patient is examined by a doctor. If there is a need, sedatives will be appointed. The procedure is carried out under local anesthesia in adults and general anesthesia in children.

Research of blood

How to recognize patient blood tuberculosis? With damage to this disease, it occurs small changes. In patients with a common pathological process, anemia is determined by pronounced intoxication. In case of exacerbations of the disease, the SE indicator (erythrocyte sedimentation speed) increases. It changes the number of leukocytes, which also contributes to the decay of the lung tissue.

Biochemical blood test shows a large protein content, uric acid, cholesterol, copper. It is worth noting that all these indicators do not necessarily indicate tuberculosis. It is possible that another infectious disease is developing in the body. Therefore, it is recommended to carry out comprehensive diagnostics.

Study urine

Usually, urine analysis is not able to determine tuberculosis in adults and children. A more accurate diagnostic method is sowing a sputum or a manta sample. But to draw up a complete picture to spend it. Sometimes urine analysis reveals quite serious complications. If the kidneys is exposed to the defeat, the large amount of protein, red blood cells, leukocytes are determined.

Diskintest

This diagnostic method is new. It allows you to determine with high accuracy to tuberculosis, as well as check the effectiveness of the therapy. The essence of the method is to assess the reaction of the body into two types of proteins, which are present only in the koche wand. Injection is performed, and after the result is checked. If redness in the injection site has spread to 5 mm and more, it is believed that the test is positive. This means that the examined patient is infected.

Recently, the growth of the incidence of tuberculosis is inexorably growing.

In this regard, it is worth thinking about the means of protection against such a dangerous disease. Each person since 18 years old, it is necessary to undergo an annual medical examination with X-ray research. Only it becomes possible to identify tuberculosis in the early stages of development, as well as timely treatment. If there were suspicions for the presence of a disease, it is necessary to urgently consult a doctor, pass all the necessary analyzes (sowing sputum, blood, urine). When prescribing treatment, it is not necessary to interrupt it, because it threatens with negative consequences. Tuberculosis - Dangerous disease, it can lead to death.

Methods for diagnosing tuberculosis are extensive. These methods changed, adjusting to new knowledge in medicine. Surveases and general analysis of the status were used to diagnose tuberculosis. It is important to pay attention to the basic symptoms of the disease. They are similar to manifestations of other diseases. Diagnostics of tuberculosis of lungs (including early diagnosis of tuberculosis) is carried out by a phthisiar physician.

The fight against illness is sent to the elimination of visible signs, and on the complete destruction of the transmission paths of infection. Thus it is possible to defeat the ailment. The microbiological diagnosis of tuberculosis is the main method of the survey, and the remaining methods relate to auxiliary. For example, mass fluorography, which is also used for prophylaxis.

Mass diagnosis of the disease

Mass diagnostic methods of tuberculosis - fluorography and subcutaneous sample.

Fluorography

To prevent the disease, modern methods of diagnosing tuberculosis are used. These include fluorography. Due to irradiation to sessions, they will move once a year if the patient has no deviations. Diagnosis of tuberculosis with fluorography is carried out several times a year. So it pass people who work with patients with tuberculosis.

Photo 1. Fluorographic study for accurate diagnosis of tuberculous disease of the lungs and control of the treatment process.

The purpose of fluorography is to discover such hidden pathologies of light, like tuberculosis and various tumors of other organs. The image happens:

• petty;
• rubbard;
• electronic.

The latter are obtained through a special apparatus with a computer. But despite the visible positive parties, there are cons. Equipment for fluorography expensive, it is hard to transport, it breaks.

Photo 2. Electronic fluorography - a more accurate and convenient method for the diagnosis of tuberculosis diseases in patients.

In addition, the state does not send some categories of citizens to the examination. These include unemployed, homeless people who suffer from drunken alcoholism, drug addicts. Among these layers of the population, tuberculosis arises more often.

Tuberculinidiagnostic

Another way to determine the disease is tuberculinidiagnosis. The second name is the test of manta. Experts explore how the body responds to the introduction of a foreign substance. The procedure is used among children, since they are contraindicated fluorography.

Photo 3. Mantu reaction is one of the methods of mass diagnosis of tuberculosis diseases among the population.

With the help of the method, the koche wand is diagnosed with tuberculosis in patients with HIV. All people in whom the sample gave a positive reaction, and other diagnostic methods are also held.

How do you know that the reaction is positive? A seal appears at the subcutaneous administration of the drug. If you press it, it will redden, but usually remains white. If it is not, then tuberculosis is recorded. Infection is possible when inflammation occurs without pressing. Protective cells that are familiar with the disease are reacted with tuberculin bacteria.

Another similar method is Diskintest. When using it, the likelihood of accurate diagnosis is 90%. The same indicator in the reaction of manta is 60-70%.

Photo 4. Assessment of the results of the skin test for detecting tuberculosis in the absence of specific symptoms of the disease.

The main symptoms of tuberculosis

To establish infection, the symptoms are checked with all attention. It happens that they are similar to other diseases. In this case, experts explore the sputum that comes out with the cough. The doctor clarifies how signs of the disease appeared. If within a few months, then it is tuberculosis. With it, symptoms do not arise in one moment.

With a clinical inspection of the patient, the doctor learns whether a significant decrease in the patient's weight was to check the lymph nodes, a violation of the amplitude of the chest motion during breathing. Of course, the first methods for the detection of tuberculosis are not fully reliable, and to make sure the development of the disease is carried out, and other analyzes are carried out, but it is these two stages that determine the need to send a patient to a special examination. According to them, it is already possible to make an approximate clinical picture and put forward the assumption about the presence of an ailment.

The main features of tuberculosis include:

• permanent cough;
• expectoration of blood;
• painful feelings in the chest;
• fever.

Symptoms (except for hemlook) must last more than 3 weeks. In this case, there are no special features of tuberculosis. The diagnosis is done only by a phthisiarter. With poor quality or late treatment, you just make it difficult.

Photo 5. Permanent dry cough acts as an early sign of the tuberculous lung disease.

Patients with tuberculosis losing kilograms during the disease. They have sweating and fever, the appetite disappears. Cough is the main respiratory symptom. These include wheezing in lungs, fatigue, constant colds. Menstruation disappear in women.

When highlighting sputum, it is necessary to carry out it for the presence of a causative agent of the disease. Patients dying and due to blood loss with hemoptysis. Breast pain is a consequence of muscle tension, which becomes stronger when inhaling.

Physical signs will tell a lot with a competent approach. It is noted that the patient's well-being is good and it does not experience a general alert with tuberculosis. Fever is rarely present, the temperature rises in the evenings.

Due to the inconspicuous symptoms and their gradual development, the patient appeals to the doctor with a delay, preferring to be treated by folk methods. But it is recommended to immediately ask specialists about help. The collection of complaints is important at the initial stage.

Photo 6. Tuberculosis disease is often accompanied by a significant decrease in body weight and the weakness of the patient.

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Examination methods for suspicion of tuberculosis

The doctor collects information not only by medical methods. When diagnosing tuberculosis at an early stage, the patient's sensation is also important. The patient should give honest answers to the questions of the doctor.

Questions are this type:

1. Are present complaints to the infection of tuberculosis earlier?
2. Have contacts with patients with tuberculosis relatives?
3. What were the results of the last fluorography? When was it on? Was there a re-procedure after this session? If so, then indicate on what grounds.
4. What social conditions are you? Bums, people with alcohol and narcotic dependencies are sick more often.
5. When and how the first symptoms manifested themselves - instantly or have developed for some time?
6. Tell us about the character of symptoms in stages.
7. Have you tried to influence the course of the disease on your own? If so, tell us about the methods.

Do not forget about the importance of examining the patient. It takes a sample of sputum. This method is safe for the patient. It allows you to determine the presence of infection in the early stages. Tuberculinidiagnosis and other methods of detection of disease - radiographic and laboratory are carried out.

Photo 7. Timely appeal to qualified medical care for the treatment of tuberculosis of the respiratory system.

Radiological examination methods

Radiological methods for diagnosing tuberculosis include:

• fluorography;
• radiography;
• x-ray;
• tomography.

The diagnosis of tuberculosis of light x-ray is carried out in the case when the doctor has suspicion of the disease. Recently, an ECM equipment is used to improve the quality of the image and the reliability of the survey. Radioscopy is more often used to preliminary status evaluation. This is an inexpensive way in which the body is evolving. At the same time, doctors study it on the screen.

Photo 8. Radiographic examination is used to form a correct diagnosis in suspected tuberculous lung disease.

Failure of the method is a low percentage of reliability. It is not possible to consider tumors and a hearth disease. Radiography is a preferential tool for early diagnosis of tuberculosis. The snapshot of the tumor and the bones will be blond, pale. Chest and air - black. Radiography is carried out periodically, and thanks to this, the therapist and the phthisiar are monitored.

Tomography is used to detail the image. It turns out clear, not "lubricated". Separate objects are not superimposed on each other. This is important at the later stages of tuberculosis and for therapy.

Photo 9. Computer tomography device, which is used to study the lungs with accurate diagnosis of tuberculosis.

Laboratory diagnostic methods

Modern microbiological studies:

• samples of sputum during primary handling;
• cultural method;
• determination of response to subcutaneous administration of the drug;
• molecular genetic method;
• bacterioscopy.

Separate container is prepared for wet collection. It should be closed, durable, prevent accidental sample leakage. In the study of sputum, there is a risk to get infected and those who are meaningful. Persons who are engaged in laboratory studies are undergoing preventive examinations more often, and the procedure is carried out in special laboratories closed from outsiders.

The table shows the order of surrender samples of sputum for the diagnosis of tuberculosis.

Another examination method is washing the bronchi. This allows you to prevent the defeat. With bronchial asthma, this procedure is prohibited. It is also not recommended to hold an elderly.

If other groups of system research methods have not helped, instrumental bronchoscopy is used. This complex involves the collection of the sample directly from the bronchi. If there are typical changes characteristic of the disease, bronchoscopy will noted. The diagnostic method is considered progressive, but you need to remember the limitations. Another variety is tracheobronchoscopy.

Photo 10. The principle of bronchoscopy - the inspection method and assessment of the state of mucous tracheas and bronchi.

Mass diagnosis of tuberculosis is required. It allows you to determine hidden pathologies in most citizens. Contact your doctor in the case of the presence of basic symptoms. The earlier you find yourself in medical institutions, the faster the definition of the diagnosis. During the survey, let's honest answers - it will save time.

• How to identify tuberculosis yourself
• Basic research methods
  • X-ray and tomography
  • Varieties of kiqueties
• Microbiological diagnostics of tuberculosis
• Detection of tuberculosis in children of different ages

The disease provokes a group of bacteria that causes tuberculosis in humans, the diagnosis of which is often difficult to diagnose. Mass diagnosis should be carried out in all people regularly. Therapists and pediatricians monitor all patients to survey for the presence of this disease.Individual diagnostics are carried out in people who have symptoms of the disease.

Mycobacterium tuberculosis is the so-called complex of pathogens affecting the human body. The most common pathogen is mycobacterium, known as Koch's wand. All of them are gram-positive acid-resistant sticks of the actinomycete family, kind of mycobacteria. They are able to hit weakened organisms with a poorly operating immune system. Since the main protection against this disease is immunity, any person may be ill with tuberculosis regardless of his social status. Tuberculosis develops unnoticed, because the pathogen of the disease is still not enough to ensure that the organism's stormy reaction occurred. Therefore, mass diagnosis is carried out.

When the disease is identified at an early stage, it is cured completely.

When the organism is defeated by mycobacteriums causing tuberculosis, a wet cough begins in a person. It is a long time and is accompanied by a hemoplange, a slight increase in temperature. In this case, there is a decrease in appetite and weight, fatigue increases.

There are mood differences. A man begins to be annoyed, he develops a general weakness and a decrease in operability. At night there appears high sweating. Night sweats indicate that the body is sick. With a general ailment, passing within a month, you should consult a doctor to clarify the reasons.

In rare cases, the symptoms of tuberculosis can manifest themselves at high temperature, which reaches 39 ° C. The patient appears in the chest and back in the lung area. Hard dry cough appears. He sweats greatly during sleep. Evenings, he begins fever with a strong sweating. Permanent cough should alert the patient. He is regarded as a symptom of tuberculosis.

Rules, how to recognize tuberculosis at home, do not always work, because ORVI and flu have similar signs. Most often, the development of tuberculosis in adults is determined only in the doctor's office during examination. He appoints an additional examination.

Various methods for the diagnosis of tuberculosis produced in special medical institutions, in tuberculous dispensaries and laboratories, help produce a qualitative examination of the body and detect tuberculosis. Only timely diagnosis and proper treatment under the supervision of the phthisiatra are able to help cure a sick person completely. Self-medication in this case is a useless spending time.

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Basic research methods

During the diagnosis of the disease, the respiratory impact, use a variety of methods for detecting tuberculosis to clarify the diagnosis. Conducting various studies of patients, select the most efficient.

The presence of similar symptoms in different diseases affecting the respiratory system leads to errors in recognizing this disease. Diagnose tuberculosis is difficult, because the complaints of the sickness of the same type, a careful examination is required to confirm the diagnosis.

How to diagnose tuberculosis, phthisiators are known to be sent to patients at the very first suspicion of development in the body of koche sticks.

Traditional methods for detecting tuberculosis are carrying tuberculin samples and mass fluorography. The advantage of these methods is high throughput and mobility. If the doctor saw the lungs, it sends a patient to radiography and tomography of the chest organs.

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X-ray and tomography

X-ray - an important method that helps to identify tuberculosis in a timely manner. It allows you to visually see lung defeats, this can be enough to confirm the diagnosis. To do this, you need to make a straight overview and side radiograph from the defeat.

X-ray tomography is required to clarify the nature of changes in the lungs. With this type of surveys, layer-by-layer mapping of lung tissue is obtained. This allows you to clarify the structure of pathological changes.

Computer tomography occupies the main place in the comprehensive diagnosis of tuberculosis. This method makes it possible without increasing the radial load to establish localization, length, complication of the tuberculosis process. With the help of this type of survey, you can get a three-dimensional image of the affected organ and confirm tuberculosis. The diagnosis in the initial stage is carried out with tuberculin samples.

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Varieties of kiqueties

Tuberculin samples are performed by health workers according to various methods to identify the sensitization of the body to tuberculosis mycobacteriums.

There are mass and individual tuberculin diagnostics. Mass diagnosis implies the annual setting of samples for children and adolescents. This makes it possible to identify the disease at an early stage of development. Individual sample performance is carried out during treatment or for the purpose of differential diagnosis.

More common is the manta test, which is performed in the form of subcutaneous administration of tuberculin. The result is estimated after 2-3 days. It is considered positive if Papula has a diameter of 5 mm and more. If papula in children has a size of 17 mm, and in adults - 21 mm, then this is regarded as a hypergic reaction. Such patients are sent for an additional examination.

Sample pirch - Corrective sample on the inner surface of the forearm. It is made by the treated tuberculin as a scarifier, causing a scratch on the skin. After three days, the reaction is evaluated. In modern diagnosis, this type of sample does not apply due to poor data quality. This type of sample was modified into a graded trial of the pitch, which is used in pediatrics.

Individually can hold other special tests using tuberculin.

Tuberculosis is a dangerous infectious disease having high social significance. Often the disease has no pronounced manifestations, and children are a source of infection with tuberculosis. Therefore, today, more than ever, the full and timely diagnosis of tuberculosis in children is important.

However, disputes relative to vaccination from tuberculosis in the hospital and its further annual diagnostics with the help of the Mantu sample have been going on for a long time. Many parents write a refusal to manta, are looking for information about alternative methods for diagnosing, reliability and accuracy of results. And this is important, since those who refuse to sample Mantu face problems when entering a kindergarten and school, since they require X-ray and certificate from the phthisiatra about the absence of vision. What methods of diagnosing tuberculosis exist today?

Sample mantu

The formulation of intradermal sample Mantu is the most common method of diagnosing tuberculosis. Its essence is that a particular substance is introduced into the child's body - tuberculin is a component of tuberculosis microbacterium. Three days later, the doctor assesses the degree of reaction of the body on it.

The test of manta is carried out by children, starting with one year old age annually before adulthood.

Pros:

Low cost, simplicity, mass of use, the possibility of coverage of a large number of children.

Minuses:

Non-standard method of administration of the drug, special care for the injection site, the likelihood of false-positive and falsely negative results, the effect of external and internal factors on the result of the sample.

The manta test is not a vaccination, as many parents are mistakenly thinking. This is a special test that shows the presence of immunity to mycobacteriums in the body. When conducting samples, it is estimated to evaluate the body's skinny reaction to the introduction of a fragment of mycobacteria. For the reaction and evaluation of the immunity of these fragments is quite enough. At the same time, there is no risk of infection due to its meager amount.

The introduction of this substance the body recognizes as a "tuberculosis infection", for which it begins to give the reaction.

Reaction mechanics:

If a person at least once in his life contacted mycobacteriums, the reaction will be positive because there are immune cells in the body that will give the skin reaction;
If there were no contacts, the reaction will not be, as will not be immunity, respectively.

Sample results Mantu:

normal immunity (Papula from 5 to 15 mm). If the child has a contact with a microbe that has not crushed into the disease, if it begins from tuberculosis, then the Mantu reaction will be positive and moderate. No further action is required by these children.
no immunity (Track from the injection, papula up to 2 mm), if the child has never contacted and was not vaccinated from tuberculosis, or the immunity of UGAS has been given a long time, then the sample will be negative. Such children are recommended to revocating from tuberculosis.
excessive, strongly expressed answer (Papula is more than 16 mm, swelling, red, more serious reactions) - recent infection of the child with tuberculosis (dupid), the presence of infection in the body. The reaction will be hyperairgic, that is, strong and bright, and the size of the papula is very large. Such a child requires consulting in a phthisiatra, carrying out additional research and the exception of tuberculosis.

What is the difficulty with testing manta?

Since the test results are estimated after three days, during this time, many factors can affect the development of the reaction, which can reduce its accuracy.

If the child has recently been vaccinated, he had fallen into infections or had an exacerbation of chronic pathology, he allergic, cleaned the sample place, stuck it with a plaster, smeared by antiseptics - the reaction can be distorted.
Also incorrect results can give a violation of the technique of conducting (introduced incorrectly) or the quality of tuberculin (stored or transported incorrectly).
The reaction may occur in the presence of microbes, similar to tuberculosis in the organism, or in the presence of allergies (especially long-lasting dermatitis), including the substance itself.
Thus, the reaction of Mantu gives only general ideas about whether immunity is to tuberculosis or not. Only children with a positive reaction are directed to more thorough surveys. They may not be infected, but it is worth eliminating such pathology.

Diskintest

This test was designed to eliminate cases of false-positive Mantu reaction.

Pros:

Allows you to specify and cut off the false-positive reactions of Mantu,
makes it possible to eliminate errors
Apply from those children whose parents against Mantu.

Minuses:

Can give falsely negative results at an early stage of infection, up to 4-6 weeks,
may depend on the technique of sampling
It is more expensive than Mantu, may not be carried out everywhere.

The method of its conduct is similar to Mantu: a substance occurs in the forearm area, which occurs exclusively in the tuberculous bacteria themselves.

Diskintest sees reactions:

In children infected with nonopegenic types of mycobacteria (they are similar to tuberculosis, but there are no diseases),
children who recently got vaccinated from tuberculosis and the reaction of the Mantoua is sharply positive,
In controversial cases with the reaction of Mantu,
With the refusal of parents from Mantu.

Thus, the holding of a diascreen pulls out the children with allergies to tuberculin, children with false positive reactions and shows precisely those children who are suspicious to infect tuberculosis or who are sick. It is usually prescribed after the test of Mantu, to clarify and clarify the situation.

What affects the results?

Just as the reaction of Mantu, Diskintest requires special conditions. It can not be put:

With acute and exacerbation of chronic diseases,
After the recent exacerbation of allergies,
under skin diseases
For a month after the last vaccination.

If the reaction of the diaxective is positive, to panic again early, you need consultation of the phthisiarature and the use of other, more complex diagnostic methods.

Quantiferonic test

One of the modern methods for diagnosing tuberculosis, which helps in identifying both active and hidden (latent) tuberculosis. This laboratory method identifies a specific interferon in the blood, which can only appear in children infected with tuberculosis.

Pros:

Held in the tube, there are no errors due to the influence of external factors,
In 100% of cases of a positive result indicates infection with tuberculosis, sielding false reactions,
may be carried out regardless of vaccination and child disease, there are no contraindications and adverse reactions,
It does not depend on vaccination from tuberculosis.

Minuses:

In 10% of cases, there is false-denial reactions (when infected with a special strain of "cow" tuberculosis),
does not give differences between infection and illness (for this you need to conduct and manta, and diaskinteste),
It is expensive, it is possible to make it not in all laboratories.

Thus, there is no ideal and unified method of diagnosing tuberculosis. All methods are carried out comprehensively and gradually. This allows you to identify children who need consultation of the phthisiatra, preventive treatment or already full-fledged anti-tuberculosis therapy.

What tests are officially recognized as suitable for admission to children's institutions?

Mantu's sample is a screening sample that sifts children with the norm and dubious reactions, and all other samples are already carried out at the direction of the phthisiatra doctor, if tuberculosis is suspected or false reactions. Many parents decide that the test is new and expensive, then it is an alternative, but no. All tests are not 100% and are held only after Mantu.

That is, the procedure is as follows: First, the manta test is done, and if it is positive, then to exclude false-positive tests, they turn to the phthisiatra and hold a diaskintest. If doubts are still left, then you can make a quantiferonic test. Although he, too, not all infection options. Thus, it is this combination: Mantu + Diskintest - in case of doubt parents gives the most accurate "answer", there is a dupid or not.

There are norms according to which, in children's institutions, they are taking or the results of the Mantu sample, or X-ray, or a conclusion from the phthisiatra. In the latter case, the phthisiart itself decides, with which test for the diagnosis of tuberculosis it will use - quantiferon or diascist.

Alena Patary, pediatrician