Tuberculosis - I.T. Pyatnochka 2005

Organization of anti-tuberculosis work during the tuberculosis epidemic

Tuberculosis is a social disease that mirrors the socio-economic well-being of the state and the welfare of its people; therefore, anti-tuberculosis measures in modern conditions must be implemented at the state level by the country's government.

Currently, the main objective in the fight against tuberculosis in Ukraine is to bring the disease epidemic under control (Stage I), stabilize epidemiological indicators (infection rate, morbidity, prevalence, and mortality) of tuberculosis (Stage 2), and then gradually reduce them (Stage 3).

The successful Organization of anti-tuberculosis measures requires close cooperation between the general medical network, the sanitary-epidemiological service, and public authorities. General organizational and methodological management of anti-tuberculosis work is carried out by the Ministry of Health of Ukraine and the F.G. Yanovsky National Research Institute of Phthisiology and Pulmonology (Scheme 1).

A tuberculosis dispensary (from the English "dispensation" - distribution) is a specialized medical and preventive facility aimed at reducing the incidence, prevalence, infection rate, and mortality of tuberculosis, as well as implementing a range of organizational, methodological, and preventive anti-tuberculosis measures among the population of the district.

The main tasks of the tuberculosis dispensary are:

1) Prevention;

2) early and timely detection;

3) Treatment of tuberculosis patients;

4) registration of categories of tuberculosis patients and high-risk groups, and monitoring their condition.

Class="center">Scheme 1 Structure OF THE anti-tuberculosis service in Ukraine

Furthermore, the decisive factor in organizing these core tasks is their active Implementation, primarily by the general medical network (prevention and detection of tuberculosis) and the anti-tuberculosis service (treatment and monitoring).

The priority in the work of the tuberculosis dispensary is the implementation of preventive anti-tuberculosis measures.

Crucial tasks of the tuberculosis dispensary also include the detection, registration, and treatment of tuberculosis patients. Treatment outcomes largely depend on the timely detection of the disease. Consequently, newly diagnosed tuberculosis patients are divided into three groups: timely detected, untimely detected, and late detected. For children and adolescents, a fourth group is designated—early detection.

The Main criteria for dividing patients into groups are The Nature of the specific process, the presence or absence of destruction (cavity) and mycobacterium tuberculosis shedding, prognosis in treatment, and the degree of risk the patient poses to healthy individuals.

The early-detected group includes children and adolescents diagnosed with:

1) tuberculin Skin test conversion;

2) primary TB infection;

3) hyperergic Mantoux test;

4) tuberculous intoxication.

The first group—timely detected—includes patients with uncomplicated forms of Primary tuberculosis: Primary tuberculosis complex, Tuberculosis of intrathoracic Lymph Nodes, limited (1-2 segments) forms of secondary tuberculosis: focal, infiltrative, disseminated without breakdown; exudative Pleurisy. The detection of MBT in the absence of pulmonary destruction does not preclude classifying the patient as timely detected. Recovery rates for such patients reach up to 100%.

The second group—untimely detected—includes patients with complicated forms of primary tuberculosis, primary tuberculosis with a chronic course, focal, infiltrative, Tuberculoma, and disseminated tuberculosis with breakdown and MBT. With modern antimycobacterial therapy, cessation of bacterial excretion occurs in 88% of cases, and healing of cavities occurs in 76%. Clinical recovery in such patients is frequently accompanied by The formation of significant residual lesions.

The third group—late detected (advanced tuberculosis)—comprises patients with fibro-cavernous, cirrhotic, Chronic disseminated tuberculosis with a cavity, and Pleural Empyema. This is the most unfavorable group clinically, prognostically, and epidemiologically. The reasons for untimely detection include Specific features of the disease course (asymptomatic progression, presence of comorbid conditions), the patient's neglect of their health (alcohol abuse, drug use, low health literacy), and physician diagnostic errors (reduced clinical suspicion of tuberculosis among general practitioners).

Main Methods of Tuberculosis detection.

1. Preventive examinations (children: tuberculin skin testing; adolescents: tuberculin skin testing, with fluorography additionally from the age of 15; adults: fluorography).

2. Detection upon seeking medical care.

3. Monitoring of individuals at high risk for tuberculosis.

The primary methods for detecting tuberculosis include radiological examination, tuberculin skin testing, and microbiological Diagnostics.

The main method for early detection of tuberculosis in children under 14 years of age is annual mass preventive screening using the Mantoux test with 2 TU. Adolescents (aged 15 and older) undergo fluorography In addition to tuberculin skin testing. Conscripts are examined at military enlistment offices if more than 6 months have passed since their previous examination.

Universal population screening is conducted starting from the age of 18, once every 2 years. However, in regions where the tuberculosis incidence does not exceed 30 per 100,000 population and the percentage of newly diagnosed fibro-cavitary tuberculosis does not exceed 0.5%, universal fluorographic screening is performed once every 3 years.

Special attention is paid during preventive fluorographic examinations to the so-called "mandatory contingents." These are individuals who have direct contact with children and adolescents: 1) staff of medical, recreational, and educational institutions for children and adolescents under 18 years of age, as well as maternity hospital personnel; 2) food service workers, catering staff, dairy farm workers, and trade personnel—in other words, individuals handling food products; 3) employees of public Sanitary and hygienic services, hotels, dormitory residents, and students in vocational and higher educational institutions whose professions fall under the "mandatory contingents" category. All these groups are subject to fluorographic examination upon employment, and subsequently once a year. Inmates in pre-trial detention facilities are examined twice a year.

Detection of tuberculosis upon seeking medical care accounts for up to 50% of patients. Finding these cases largely depends on the phthisiatric vigilance of the general healthcare network, primarily general practitioners and internists.

High-risk groups for tuberculosis. General outpatient clinics monitor individuals with gastric and duodenal ulcers, those who have undergone surgery for these conditions, patients with Diabetes Mellitus, occupational dust-induced lung diseases, chronic obstructive pulmonary disease (COPD), a history of exudative pleurisy, chronic adrenal insufficiency, chronic non-specific diseases, alcoholism, and substance abuse; individuals who have undergone prolonged corticosteroid or Radiation therapy; those with small post-tuberculosis pulmonary scars, as well as major residual changes from non-specific lung diseases.

Pregnancy, the postpartum period, and AIDS are also classified as high-risk factors for developing tuberculosis.

Individuals belonging to risk groups undergo fluorographic screening once a year at general healthcare facilities.

Tuberculosis dispensaries monitor high-risk populations for tuberculosis and its recurrence who belong to Category 5 (Cat 5). Category 5 (Cat 5) is subdivided into five groups: 5.1, 5.2, 5.3, 5.4, 5.5.

Group 5.1 includes individuals with residual changes following cured tuberculosis of various localizations. The duration of dispensary monitoring depends on the extent of the residual changes. Individuals with minor residual changes are monitored for 3 years, while those with extensive changes are followed for 10 years. Patients with large tuberculomas (exceeding 4 cm in diameter) and widespread pulmonary cirrhosis should be monitored for life, whereas children and adolescents with residual tuberculosis changes are observed until the age of 18.

Group 5.2 comprises individuals who have contact with tuberculosis patients shedding MBT, as well as with animals sick with tuberculosis. This group includes young children in contact with patients who have active tuberculosis but do not shed MBT, as well as children whose parents are in contact with animals infected with tuberculosis. Individuals in this group should be monitored throughout the entire period of contact with bacterial excretors (for children and adolescents, also with patients having active tuberculosis who do not shed MBT) or with farm animals suffering from tuberculosis. Following the cessation of contact (death or departure of the infectious patient), monitoring continues for 1 year.

Group 5.3 includes adults with tuberculosis-like changes of undetermined disease activity. The monitoring period for this group is 3 months.

Group 5.4 includes children and adolescents infected with tuberculosis, as well as those from risk groups (tuberculin conversion, hyperergic reaction to tuberculin, an increase in tuberculin sensitivity by 6 mm per year, and the presence of chronic somatic diseases). Their monitoring period is 1–2 years. This group also includes children who were not vaccinated with BCG during the neonatal period or who have experienced post-vaccination BCG complications. Their monitoring period is 1 year.

Group 5.5 includes children and adolescents for whom it is necessary to clarify the Etiology of tuberculin sensitivity (post-vaccination vs. infection-induced allergy) or to perform Cytology/practical/136.html">Differential Diagnosis OF pulmonary and extrapulmonary lesions, as well as cases with respiratory tract tuberculosis changes of uncertain activity.

Dispensary Monitoring Groups. Tuberculosis dispensary populations are categorized into groups and subgroups, enabling differentiated screening, targeted treatment strategies, and the implementation of preventive and rehabilitation measures (Tables 11, 12, 13, 14).