Tuberculosis - I.T. Piatnochka 2005

Clinical Classification of Tuberculosis

According to the International Statistical Classification of Diseases and Related Health Problems (ICD), 10th Revision, recommended by the WHO (1992), tuberculosis is classified under infectious and parasitic diseases, divided into five categories:

A15. Respiratory tuberculosis, bacteriologically and histologically confirmed.

A16. Respiratory tuberculosis, not bacteriologically or histologically confirmed.

A17. Tuberculosis of the Central Nervous system.

A18. Tuberculosis of other Organs.

A19. Miliary tuberculosis.

In Ukraine, a slightly modified Clinical Classification of Tuberculosis was adopted and approved by the Order of the Ministry of Health of Ukraine No. 499 dated October 28, 2003. This classification is adapted to the international standard and ensures a unified perspective, common terminology, and mutual understanding among medical professionals worldwide. The classification covers the entire patient monitoring cycle: “Diagnosis of tuberculosis indicating confirmation Methods – Selection of Treatment category – selection of dispensary category – evaluation of treatment efficacy and outcomes.”

I. Type of tuberculosis process:

1. Newly diagnosed tuberculosis – NDTB (date of diagnosis)

2. Tuberculosis relapse – RTB (date of diagnosis)

3. Chronic tuberculosis – CTB (date of diagnosis)

II. Clinical forms of tuberculosis (ICD-10 codes)

A15.-A16. - Pulmonary Tuberculosis (PTB) (with optional indication of the lesion form)

A15.-A16. - Primary tuberculosis complex

A19.- part - Disseminated pulmonary tuberculosis

A15.-A16. - Focal pulmonary tuberculosis

A15.-A16. - Infiltrative pulmonary tuberculosis

A15.-A16. - Caseous Pneumonia

A15.-A16. - Pulmonary Tuberculoma

A15.-A16. - Fibrocavernous pulmonary tuberculosis

A15.-A16. - Cirrhotic pulmonary tuberculosis

A15.-A16./J65 Pulmonary tuberculosis combined with occupational dust lung diseases (coniotuberculosis)

A15.-A18. - Extrapulmonary tuberculosis (EPTB) (with indication of localization)

A15.-A16. - Tuberculosis of Bronchi, Trachea, Larynx, and other Upper Respiratory Tract

A15.-A16. - Tuberculosis of intrathoracic Lymph Nodes

A15.-A 16. - Tuberculous Pleurisy (incl. empyema)

A17 Tuberculosis of The Nervous System and Meninges

A18.0 Tuberculosis of Bones and joints

A18.1 Genitourinary tuberculosis

A18.2 Tuberculous peripheral lymphadenopathy

A18.3 Tuberculosis of intestines, Peritoneum and mesenteric lymph nodes

A18.4 Tuberculosis of Skin and subcutaneous tissue

A18.5 Eye tuberculosis

A18.6 Tuberculosis of ear

A18.7 Adrenal tuberculosis

A18.8 Tuberculosis of other specified organs and systems

A18 Tuberculosis of unspecified site

A19 Miliary tuberculosis (TB)

Note: 1. Respiratory tuberculosis (RT), or tuberculosis of the Respiratory system, includes tuberculosis of the Nose, Paranasal Sinuses, larynx, trachea, bronchi, Lungs, and thoracic cavity (Pleura, intrathoracic lymph nodes).

2. The "dot-dash" sign (.-) indicates the inclusion of the fourth (fifth) digit when coding nosologies according to ICD-10.

III. CHARACTERISTICS OF THE Tuberculous Process

1. Localization of the lesion

The localization of pulmonary lesions is indicated by the number (name) of segments and the names of lung lobes, while in other organs and systems, it is indicated by the anatomical name of the lesion site.

2. Presence of destruction

(Destr +) destruction present

(Destr -) no destruction

optionally, the phase of the tuberculous process should be indicated:

✵ infiltration, disintegration (corresponds to Destr +), dissemination;

✵ resorption, compaction, scarring, calcification.

3. Etiological confirmation of the tuberculosis diagnosis

(MB T+) confirmed by Bacteriological examination (code A15), in which case specify:

(M +) positive result of acid-fast bacilli (AFB) smear Cell/15.html">Microscopy;

(C 0) culture examination was not performed;

(C -) negative result of culture examination;

(C +) positive result of culture examination; in which case specify:

(Resist 0) M. tuberculosis resistance to first-line drugs was not tested;

(Resist -) resistance to first-line drugs was not detected;

(Resist +) (abbreviation of first-line anti-tuberculosis drugs) M. tuberculosis resistance to first-line drugs was detected (list all first-line drugs to which resistance was established in parentheses).

(Resist II 0) M. tuberculosis resistance to second-line drugs was not tested;

(Resist II -) resistance to second-line drugs was not detected;

(Resist II +) (abbreviation of second-line anti-tuberculosis drugs) M. tuberculosis resistance to second-line drugs was detected (list all second-line drugs to which resistance was established in parentheses).

Note: in cases of tuberculosis of unspecified localization with (MB T+), the type of biological sample examined should be indicated, for example, sputum (MB T+), urine (MB T+).

(MB T-) not confirmed by bacteriological examination (code A16), in which case specify:

(M 0) smear microscopy was not performed;

(M -) negative result of acid-fast bacilli (AFB) smear microscopy;

(C 0) culture examination was not performed;

(C -) negative result of culture examination;

(Hist 0) histological examination was not performed;

(Hist -) not confirmed by histological examination (code A16);

(Hist +) confirmed by histological examination (code A15).

IV. Complications of tuberculosis

It is necessary to list the complications and indicate the date of their diagnosis in parentheses.

Complications of pulmonary tuberculosis (PT): hemoptysis, Pulmonary Hemorrhage, Spontaneous pneumothorax, respiratory failure, chronic Cor Pulmonale, Atelectasis, amyloidosis, etc.

Complications of extrapulmonary tuberculosis (EPT): bronchial stenosis, Pleural Empyema, fistula (bronchial, thoracic), renal (adrenal) insufficiency, Infertility, adhesion, ankylosis, amyloidosis, etc.

V. Clinical and Dispensary Registration Category of the Patient

Category 1 (Cat 1) Newly diagnosed tuberculosis with bacteriologically confirmed infection (NEW TB MBT+), as well as other severe and widespread (pulmonary or extrapulmonary) forms of the disease without bacteriologic confirmation (NEW TB MBT-)

Category 2 (Cat 2) Relapses of tuberculosis (RTB MBT+) and (RTB MBT-), newly diagnosed tuberculosis with treatment failure (NEW TB TF MBT+) and (NEW TB TF MBT-), and treatment after default if the patient had previously been treated for more than 1 month

Category 3 (Cat 3) Newly diagnosed limited tuberculosis (affecting less than 2 segments) without bacteriologic confirmation (NEW TB MBT-), tuberculosis of unspecified localization in children (tuberculous intoxication), tuberculosis of intrathoracic lymph nodes or Primary tuberculous complex in the calcification phase with persistent process activity.

Category 4 (Cat 4) Chronic tuberculosis (CT) of various localizations, both MBT+ and MBT-.

Category 5 (Cat 5) Risk groups for developing tuberculosis or its reactivation

Group 5..1 residual changes of cured tuberculosis,

Group 5.2 close contacts,

Group 5.3 adults with tuberculous lesions of undetermined process activity,

Group 5.4 children and adolescents with latent tuberculosis infection, individuals from risk groups, as well as unvaccinated newborns and children with post-vaccination complications.

Group 5.5 children and adolescents requiring clarification of the Etiology of tuberculin sensitivity or The Nature of pulmonary changes for Differential diagnosis.

Note. When formulating a tuberculosis diagnosis for patients in each category, the cohort code (1, 2, 3, 4) should be indicated along with the cohort year in parentheses, for example, Coh4(2001), Coh1(2000), Coh3(2002). With such cohort coding, patients are transferred to dispensary follow-up.

VI. Treatment Outcomes for Tuberculosis Patients

1. Effective treatment:

1.1. Cure

1.2. Cessation of bacteriologic excretion.

2. Treatment completed

3. Treatment failure

4. Treatment interrupted (default)

5. Treatment ongoing

6. Transferred out / Defaulter

7. Death

Note. "Effective treatment" and "Treatment completed" are combined into "Successful treatment".

VII. Sequelae of Tuberculosis (B90)

Residual changes after cured pulmonary tuberculosis:

fibrotic, fibrofocal, bullous-dystrophic changes, calcifications in the lungs and lymph nodes, pleuropneumosclerosis, cirrhosis, consequences of surgical intervention (indicating the type and date of surgery), etc.;

Residual changes after cured extrapulmonary tuberculosis: cicatricial changes in various organs and their sequelae, calcifications, consequences of surgical intervention (indicating the type and date of surgery).

Formulating a tuberculosis diagnosis.

A tuberculosis diagnosis should be formulated in the following sequence: type of tuberculous process (as an abbreviation indicating the date it was established), clinical form, localization of the lesion, destruction (phase of the process), method of diagnosis confirmation (MBT + or MBT -, Hist + or Hist -), and complications.

Examples of diagnosis formulation:

1. NPTB (22.06.1999) of the upper lobes of the lungs (disseminated), Dest +, MBT+M+C+, Resist 0, Hist 0, pulmonary hemorrhage, Cat1Coh2(1999).

The physician's error here is that, despite the presence of MBT+M+C+, drug resistance testing of MBT was not performed.

2. CTB (12.01.1999) of the upper lobe of the right lung (fibrocavernous), Dest+, MBT+M+C+Resist+(NDD), Resist II+(K, Eth, Amic, Zip), Hist0, CRD, Cat4Coh1(1999), right-sided upper lobectomy (27.05.1999), acute cor pulmonale (28.05.1999), death (29.05.1999).

The physician's error here is that the patient with chronic tuberculosis did not undergo antimycobacterial therapy according to Category 4 for 18–24 months, and the undertreated patient with stage II chronic respiratory failure (CRD) was operated on, which led to complications and death.

3. NPTB (12.06.1999) miliary pulmonary tuberculosis, Dest-, MBT- M-C-, Hist+, Cat1 Coh3(1999), lost to follow-up (13.10.1999).

The physician's error here is the incorrect choice of cohort; since the patient was diagnosed with tuberculosis on June 12, 1999, treatment should have been initiated immediately and the patient assigned to the second cohort (Coh2), but the physician assigned the patient to the cohort with a delay—in the 3rd quarter (Coh3). It is possible that the tuberculosis was diagnosed in the 2nd quarter, but treatment was started in the 3rd quarter. This indicates a lack of cooperation between the physician and the patient or the physician's unfamiliarity with cohort assignment rules.

Modification of a tuberculosis diagnosis based on treatment outcomes. Given the current level of therapeutic capabilities, There is a need for timely revision of the diagnosis, especially when initial smear microscopy results were negative at THE START OF treatment, but positive culture results were obtained during the course of treatment (after 1.5–2 months). For those opting to record clinical forms and Phases of the tuberculous process on an elective basis, revision during treatment is also possible. The process phase can be changed at any stage of patient monitoring depending on their condition. The diagnosis (clinical form of tuberculosis) must be changed immediately after a different clinical form of tuberculosis is diagnosed in the patient.

Regarding patients who have undergone surgery for pulmonary tuberculosis, it is recommended:

a) for individuals who have no residual tuberculosis-related Changes in the lungs after surgery, the diagnosis should be stated as: "State after surgical intervention (indicate The Nature and date of the intervention) due to a specific form of tuberculosis";

b) when certain tuberculous changes persist in the remaining or collapsed lung tissue, or in another organ, the diagnosed form of tuberculosis should be taken into account, and the type of surgical intervention performed for tuberculosis should also be indicated.

CONTROL QUESTIONS

1. Main headings of the tuberculosis classification.

2. Clinical forms of respiratory tuberculosis.

3. What does METABOLISM/2.html">THE CONCEPT OF "characteristics of the tuberculous process" include?

4. Types of the tuberculous process.

5. Complications of respiratory tuberculosis.

6. Formulation of a diagnosis of respiratory tuberculosis.

7. Modification of the diagnosis As a result of treatment.

TESTS

1. Primary forms of tuberculosis include:

A. focal

B. disseminated

C. tuberculous intoxication

D. caseous pneumonia

E. infiltrative

2. Specific complications include:

A. hemoptysis

B. chronic cor pulmonale

C. atelectasis

D. laryngeal tuberculosis

E. amyloidosis

3. Progression of the tuberculous process is characterized by the phase of:

A. resorption

B. dissemination

C. compaction

D. scar formation

E. calcification

4. When formulating a clinical diagnosis of pulmonary tuberculosis, the first to be indicated is:

A. phase of the process

B. clinical form

C. bacterial excretion

D. localization of the process

E. type of tuberculous process

5. A 19-year-old female underwent a routine fluorographic examination, which revealed solitary low-intensity foci with blurred contours in the apical segments of both lungs. What is the clinical form of tuberculosis here?

A. Infiltrative

B. Tuberculoma

C. Focal

D. Caseous pneumonia

E. Disseminated

6. A 25-year-old patient developed an acute illness, complaining of headache, dry cough,

dyspnea, and a body Temperature rising to 39.0 °C. Objective Examination: general condition is severe, lip cyanosis, no rales are auscultated. Blood count: WBC - 12.6x10⁹/L, ESR - 16 mm/h. A plain chest X-ray reveals multiple small, low-intensity focal shadows throughout both lungs. Mantoux test shows a 5 mm infiltrate. What is the clinical form of pulmonary tuberculosis in this patient?

A. Focal

B. Infiltrative

C. Disseminated

D. Miliary tuberculosis

E. Caseous pneumonia

7. A 10-year-old patient M. presented with a tuberculin conversion, Mantoux test with 2 TU showed a 16 mm infiltrate. Complaints of general weakness, low-grade fever, and increased sweating. Blood count: WBC 9.2x10⁹/L, ESR - 26 mm/h. X-ray Examination revealed no pathological changes in the lungs. What is the most probable diagnosis?

A. Primary tuberculous complex

B. Tuberculosis of intrathoracic lymph nodes

C. Focal tuberculosis

D. Tuberculous intoxication

E. Infiltrative tuberculosis

8. A 26-year-old patient N. underwent an X-ray examination that revealed multiple low- and medium-intensity focal shadows in the upper and middle lung fields. MBT were detected in the sputum. Blood count: ESR - 38 mm/h. What is the most probable diagnosis?

A. Infiltrative pulmonary tuberculosis

B. Focal pulmonary tuberculosis

C. Disseminated pulmonary tuberculosis

D. Caseous pneumonia

E. Fibrocavernous pulmonary tuberculosis

9. A 53-year-old patient K. underwent an X-ray examination which revealed a ring-shaped shadow 5 cm in diameter with thick walls in the upper lobe of the left lung, surrounded by fibrous strands and foci. MBT were found in the sputum. What is the most probable clinical form?

A. Cirrhotic

B. Infiltrative

C. Disseminated

D. Tuberculoma

E. Fibrocavernous

10. Indicate the incorrect formulation of the clinical diagnosis of pulmonary tuberculosis:

A. NPTB (16.06.2003) of the upper lobes of both lungs (disseminated), Dest+ (infiltration), MBT+M+K+, Resist0, Hist0, Cat1 Coh2(2003).

B. CPTB (12.02.2000) of the upper lobe of the right lung (fibrocavernous), Dest+, MBT+M+K+, Resist+(S,R), Hist0, pulmonary hemorrhage, CCC, CHF stage IIA, RF stage II, Cat4 Coh1(2000).

C. RTPB (20.11.2003) of the lower lobe of the right lung (tuberculoma), Dest+, MBT-M-K-, Hist0, RF stage I, Cat2 Coh4(2003). Diabetes Mellitus, type I, severe form.

D. NPTB (20.09.2003) (focal), (infiltration), MBT-M-K0, Hist0, Cat3 Coh3(2003).

E. Condition after right-sided upper lobectomy (20.06.2003) for tuberculoma of the upper lobe of the right lung in the decay phase, MBT (+).

11. Primary forms of tuberculosis include:

A. disseminated

B. focal

C. infiltrative

D. tuberculosis

E. tuberculosis of intrathoracic lymph nodes

12. A 52-year-old female patient has been treated for 9 months for NPTB (02.02.2002) of the upper lobe of the right lung (infiltrative), Dest+, MBT+M+K+, Resist+(H), Hist0, Cat1 Coh1(2002). X-ray examination shows that the upper lobe of the right lung has decreased in volume, a 3 cm destruction cavity is present under the clavicle, the trachea is shifted to the right, MBT (-). Indicate the form of tuberculosis.

A. Cirrhotic

B. Caseous pneumonia

C. Fibrocavernous

D. Infiltrative

E. Focal