Tuberculosis - I.T. Piatnochka 2005

Work Capacity Assessment

The assessment of working capacity for a patient with Pulmonary Tuberculosis begins at the moment of Diagnosis. In clinical practice, two MAIN TYPES OF work disability are distinguished: temporary and permanent. Furthermore, disability may be either partial or complete.

Patients are considered temporarily disabled when there are realistic Prospects of restoring their working capacity within the timeframes regulated by relevant resolutions. Temporary disability assessment is carried out by medical consultative commissions (MCC), which determine the duration of disability, refer patients to the MSEK (Medical and Social Expert Commission) to extend the sick leave certificate for the maximum permitted period, refer patients to the MSEK to establish a disability group, and issue certificates containing recommendations for rational employment.

Patients with newly diagnosed tuberculosis, relapse, or exacerbation of the process are issued sick leave certificates for up to 10 months (or up to 12 months with MSEK approval), depending on The Nature of the tuberculosis process and its dynamics under Treatment. Patients with chronic forms of tuberculosis, as well as working individuals with disabilities due to tuberculosis who experience an exacerbation or progression of the disease, are entitled to sick leave for up to 4 months continuously or with interruptions totaling no more than 5 months per calendar year.

Permanent disability is established when, despite treatment, the impairment of bodily Functions becomes irreversible, and the patient is no longer able to perform their routine professional duties—in other words, becomes disabled.

Class="center">Table 11 Dispensary observation of individuals subject to follow-up by a phthisiatrist

Categories and observation groups		Control examination schedule	Observation period	Therapeutic and dispensary measures	Criteria for treatment and dispensary effectiveness
N	Structure/97.html">Definitions	Control examination schedule	Observation period	Therapeutic and dispensary measures	Criteria for treatment and dispensary effectiveness
1	2	3	4	5	6
Cat 1	Newly diagnosed tuberculosis with bacteriologically confirmed excretion, as well as other severe and disseminated forms without bacterial excretion involving more than two segments or two or more Organs: miliary, disseminated, meningoencephalitis, exudative Pleurisy, pericarditis, Peritonitis, intestinal tuberculosis, spinal tuberculosis with neurological complications, and Urogenital tuberculosis	At least once a month during the intensive phase and once every 2 months during the continuation phase of treatment. The scope and schedule of X-ray examinations and sputum tests are given for adults in Appendix 2 and for children in Appendix 3	Until cure, completion of the main course of treatment, or exclusion from the category for various reasons: ineffective treatment, death, or transfer to another dispensary. The maximum observation period is 2 years	Comprehensive etiological and pathogenetic treatment; surgical intervention as indicated	Cure, cessation of bacterial excretion, completion of the main course of treatment
Cat 2	Relapses of tuberculosis with and without bacterial excretion, newly diagnosed tuberculosis treated ineffectively with and without bacterial excretion, and patients with treatment interrupted for more than 2 months (with and without bacterial excretion)	Similarly	Similarly	Similarly	Similarly
Cat 3	Newly diagnosed tuberculosis without bacterial excretion, with a limited pulmonary process (involving no more than two segments), and Extrapulmonary tuberculosis not classified under Category 1; tuberculosis intoxication in children, and intrathoracic Lymph node tuberculosis or Primary tuberculous complex in the phase of calcification with preserved process activity	At least once a month during the intensive phase and once every 2 months during the continuation phase of treatment	Similarly	Similarly	Cure, completion of the main course of treatment
Cat 4	Chronic tuberculosis of various localizations with and without bacterial excretion	At least once a month during the intensive phase and once every 2 months during the continuation phase of treatment. After completion of the main course, once every 3–6 months during remission	Unrestricted time	Comprehensive etiological and pathogenetic treatment; surgical intervention as indicated	Cure, cessation of bacterial excretion, completion of the main course of treatment, resolution of tuberculosis flare-up, survival
Group 5.1	Residual changes after cure of tuberculosis (RCT) of various localizations	During the first year of observation, at least once every 6 months. In subsequent years, examinations are performed at least once every 12 months	Minor residual changes of tuberculosis (RCT) — 3 years; major residual changes — 10 years; tuberculomas larger than 4 cm, widespread pulmonary cirrhosis — lifelong. Children and adolescents with RCT are observed until 18 years of age	If factors reducing body resistance are present or arise, administer anti-relapse courses of anti-tuberculosis drugs for 2–3 months	Absence of relapses
Group 5.2	Contacts — individuals in contact with bacterial excreters (for children and adolescents, also with patients suffering from active tuberculosis) or with farm animals suffering from tuberculosis	At least once every 6 months. During the period of anti-relapse treatment, it depends on the administration methodology	Throughout the entire contact period, as well as 12 months after deregistration, death, or departure	Measures aimed at sanitizing the tuberculosis infection focus and increasing the body resistance of contacts: Chemoprophylaxis, BCG revaccination of uninfected children	Absence of tuberculosis cases
Group 5.3	Adults with tuberculous changes of uncertain activity who are not registered at a anti-tuberculosis facility	During outpatient treatment, depending on the administration methodology	3 months	Comprehensive examination. If necessary, trial Chemotherapy for up to 3 months	Registration in category 1 or 5, depending on The activity of tuberculosis
Group 5.4	Children and adolescents infected with tuberculosis from risk groups (tuberculin Skin test conversion, hyperergic reaction to tuberculin, increase in tuberculin sensitivity by 6 mm per year, as well as children with chronic somatic diseases)	Control examinations 2 times a year. During chemoprophylaxis, 3 times a month	For a favorable course of infection, for one year; in case of persistent hyperergic reactions to tuberculin, as well as in those infected with chronic foci of nonspecific infection, for 2 years	A single 3-month course of controlled chemoprophylaxis upon registration. If hyperergy persists, a 3-month chemoprophylaxis course is prescribed	Absence of tuberculosis cases
	Children not vaccinated with BCG during the neonatal period Children with post-vaccination BCG complications	Unvaccinated children must be examined before BCG Vaccination once every 3 months by pediatric phthisiatricians and relevant specialists in children's polyclinics Based on medical indications, but at least once every 3 months	Prior to vaccination 1 year	Chemoprophylaxis and health improvement are carried out in sanatorium conditions, sanatorium nurseries, kindergartens, boarding schools, forest schools, and general children's and adolescent institutions Chemoprophylaxis is carried out differentially, According to the child's condition and the prevalence of Mtb drug resistance in the region and infection foci
Group 5.5	Children and adolescents in whom it is necessary to clarify the Etiology of tuberculin sensitivity (post-vaccination or infectious allergy), or the nature of Changes in the Lungs and other organs for Differential diagnosis. Children and adolescents with tuberculous changes in respiratory organs of uncertain activity	As indicated. During chemotherapy for post-vaccination complications, 3 times a month	Up to 6 months	Tuberculin Diagnostics and clinical-radiological examination in the dispensary, and if necessary, in a hospital for differential diagnosis to detect tuberculosis infection. Treatment from 2 to 4 months with repeated clinical-radiological examination to determine etiology or process activity	Transfer to category 1, 3, or group 5.4

Table 12 Scope of examination for adult cohorts under dispensary observation by a phthisiatrist

Categories and groups	Radiological examination	Laboratory tests	Examination of sputum, bronchial washings, gastric washings, biopsy specimens (bacterioscopy and culture)	Tuberculin tests
1	2	3	4	5
cat 1, 2, 3	Upon registration or hospital admission — Overview chest radiograph and lateral projections; subsequent examinations are repeated every 2 months. Tomography of affected lung parts is performed upon admission to the clinic, and then every 2 months until cavity healing, as well as upon discharge. Chest computed tomography as indicated. After cavity healing, examination once every 3–4 months	Upon registration, perform complete Blood count and urinalysis, and measure blood bilirubin and Alanine aminotransferase levels. Upon hospital admission, additional determination of blood group and Rh factor, blood and urine sugar, and blood tests for Hbs-Ag, AIDS, and Wassermann reaction are required. During the administration of anti-tuberculosis drugs, perform monthly blood and urine tests, as well as blood biochemistry (bilirubin, aminotransferases)	Upon registration, triple sputum (bronchial lavage) examination for Mtb using bacterioscopy, and triple material testing via culture on nutrient media with mandatory determination of Mtb drug susceptibility; thereafter, monthly duplicate similar tests until cessation of Mtb excretion and healing of pulmonary cavities. The cessation of Mtb excretion is confirmed by at least two consecutive negative bacteriological and culture examinations over 2–3 months	Upon registration, Mantoux test with 2 TU PPD-L
cat 4	During exacerbation, the examination is carried out as for Category 1 patients. During remission, once every 3–6 months	During hospital treatment, similar to the scope and schedule for Category 1 patients. During remission, perform complete blood count and urinalysis at least once every 3 months	During treatment with anti-tuberculosis drugs, Cell/15.html">Microscopy and culture of material for Mtb once a month, with mandatory drug resistance testing for first- and second-line drugs. During remission, once every 3 months	Similarly
group 5.1	During the first year of observation, radiograph or fluorogram once every 6 months; thereafter, at least once a year until deregistration. Tomography as indicated	Once every 6 months in the first year, thereafter once a year	Once every 6 months in the first year of observation, thereafter as indicated	As indicated
group 5.2	At least once every 6 months, and during chemoprophylaxis determined by the administration methodology	Once every 6 months	When tuberculosis is suspected	Once a year
group 5.3	Radiograph and tomography upon registration; then once every 2 months	Complete blood count and urinalysis once a month	Upon registration, then once every 2 months	Upon registration

Table 13 Scope of examination for children and adolescent cohorts under dispensary observation by a phthisiatrist

Category and group	Radiological examination	Laboratory tests	Examination of sputum, bronchial washings, gastric washings, biopsy specimens (bacterioscopy and culture)	Tuberculin tests
1	2	3	4	5
1, 2, 3	For localized forms of tuberculosis during the intensive phase of treatment, radiographs and tomograms at least once every 2 months; during the continuation phase, once every 3 months. For early tuberculous intoxication, 2 times a year. Chest computed tomography as indicated	Upon registration and in the hospital during the intensive phase of treatment, perform a monthly complete blood count and urinalysis, and determine blood levels of bilirubin, alanine aminotransferase, urea, residual nitrogen, and total protein. Upon hospital admission, determination of blood group and Rh factor, blood and urine sugar, and blood tests for Hbs-Ag, AIDS, and Wassermann reaction are required. During the continuation phase of treatment, perform a complete blood count and urinalysis at least once every 2 months, and determine blood levels of bilirubin and alanine aminotransferase	Upon registration, triple sputum (bronchial lavage) examination for Mtb using bacterioscopy, and triple material testing via culture on nutrient media with mandatory determination of Mtb drug susceptibility; thereafter, monthly duplicate similar tests until cessation of Mtb excretion, followed by monthly duplicate similar examinations for 3 months. If Mtb is detected, mandatory testing for drug resistance to anti-tuberculosis drugs	At the beginning and after the completion of treatment
4	Radiographs and tomograms for localized forms of the disease during the intensive phase of treatment at least once every 2 months, and during the continuation phase, once every 3 months. During the remission phase, once every 6 months	During hospital treatment, similar to the scope and schedule for Category 1 patients. During the remission phase, perform a complete blood count and urinalysis at least once every 3 months	Upon registration, triple sputum (bronchial lavage) examination for Mtb using bacterioscopy, and triple material testing via culture on nutrient media with mandatory determination of Mtb drug susceptibility; then monthly duplicate similar tests until cessation of Mtb excretion, followed by monthly duplicate similar examinations for 3 months. During the remission phase, material testing for Mtb once a month by microscopy, and culturally if necessary	During the main course, at the beginning and after the completion of treatment. During remission, once a year
5.1	Radiograph 2 times a year in the first year of observation, once a year until deregistration	Blood and urine analysis once every 6 months in the first year; monthly during anti-relapse courses	Once every 6 months in the first year, thereafter as indicated by microscopy and culture	Once a year
5.2	Radiograph once a year for uninfected and 2 times a year for infected individuals (for children under 3 years old, once a year)	Blood and urine analysis once every 3–6 months; monthly during chemoprophylaxis	For uninfected and infected children — once every 6 months by microscopy	Once a year
5.4	Radiograph and tomograms upon registration and deregistration	Blood and urine analysis once every 6 months; monthly during chemoprophylaxis	Upon registration and deregistration by microscopy	Once a year
5.5	Radiograph and tomograms upon registration and deregistration	Blood and urine analysis once upon registration and deregistration	Upon registration, 3 examinations by microscopy and 2 examinations by culture	Upon registration

Table 14 Characteristics of residual changes after past respiratory tuberculosis (including spontaneously cured cases)

Extent of changes	Characteristics of residual changes after past respiratory tuberculosis
Extent of changes	Primary complex	Pulmonary foci and complexes	Fibrotic and cirrhotic changes in the lungs	Pleural changes	Changes following surgical interventions
1	2	3	4	5	6
Minor	Single (no more than 5) Components of the primary complex (Ghon Focus and calcified Lymph Nodes) less than 1 cm in size	Single (up to 5) dense, well-defined foci less than 1 cm in size	Limited fibrosis within 1 segment	Obliterated sinuses, interlobar adhesions, pleurodiaphragmatic and pleuromediastinal adhesions, pleuroapical and pleurocostal layers up to 1 cm wide (with or without pleural calcification), unilateral or bilateral	Changes after segmentectomy or lobectomy in the absence of major postoperative changes in the lung tissue and Pleura
Major	1. Multiple (more than 5) components of the primary complex (Ghon focus) and calcified lymph nodes less than 1 cm in size 2. Single and multiple components of the primary complex (Ghon focus) and calcified lymph nodes 1 cm or more in size	1. Multiple (more than 5), dense, well-defined foci less than 1 cm in size 2. Single and multiple dense, well-defined foci measuring 1 cm and foci 1 cm or more in size	1. Widespread fibrosis (more than 1 segment) 2. Cirrhotic changes of any extent	1. Massive pleural layers wider than 1 cm (with or without pleural calcification)	1. Changes after segmentectomy or lobectomy in the presence of postoperative changes in the lung tissue and pleura 2. Changes after pneumonectomy, thoracoplasty, pleurectomy, cavernostomy, extrapleural pneumolysis

Partial disability is established in cases where a patient is temporarily unable to work in their specific specialty, but can perform other work without detriment to their health.

Complete disability refers to a condition where a patient requires a permanent special regimen and treatment.

Depending on the degree of disability, the MSEK establishes disability groups III, II (for 1 year), and I (for 2 years). Group III is established for minor disability; Group II is established for more significant impairment, when the patient exhibits substantial functional disorders due to tuberculosis that hinder employment, yet does not require outside supervision. Group I is established for a complete, permanent, and prolonged loss of working capacity in patients who require constant outside care.

Indefinite disability is established for men who have reached 60 years of age and women 55 years of age with severe chronic irreversible tuberculosis, as well as following lung resection and in case of significant chest deformations. The MSEK is obligated to provide disabled individuals with specific employment recommendations after analyzing working conditions and real opportunities for their improvement. Restoring the working capacity of a person who has suffered from tuberculosis is an important medical task. Medical, vocational, and social rehabilitation are distinguished after patient recovery. Medical rehabilitation involves the restoration of lost or weakened bodily functions following treatment.

The goal of vocational rehabilitation is to return tuberculosis survivors to their previous jobs or to retrain them and master new accessible professions and skills. Social rehabilitation consists in the rational utilization of the residual working capacity of patients and individuals with disabilities. This positively affects a person's psychological and emotional state, making them useful in society.

CONTROL QUESTIONS

1. Anti-tuberculosis dispensary. The Essence of the dispensary method of serving the population and patients.

2. Main tasks of the anti-tuberculosis dispensary.

3. STRUCTURE OF THE phthiopschiatric service and types of anti-tuberculosis facilities in Ukraine.

4. Main Methods of Tuberculosis detection.

5. Division of newly diagnosed patients into 3 groups.

6. METABOLISM/2.html">THE CONCEPT OF a tuberculosis infection focus, its division into groups, and health-improving and preventive work within them.

7. Disinfection and its types in tuberculosis.

8. Mandatory target groups subject to regular tuberculosis screening.

9. High-risk groups for tuberculosis.

10. Dispensary observation groups for adults.

11. Dispensary registration in children and adolescents.

12. Work capacity assessment: temporary and permanent disability, disability groups. Duration of sick leave issuance and conditions for referring the patient to the medical advisory committee (MAC) and the medical and social expert commission (MSEC).

TESTS

1. The primary method for detecting tuberculosis in children.

A. Sputum smear microscopy

B. Fluorography

C. Tuberculin skin testing (Mantoux test with 2 TU)

D. Bronchoscopy

E. Tomography at the level of the tracheal bifurcation

2. At what age are fluorographic examinations initiated?

A. 5 years

B. 7 years

C. 14 years

D. 15 years

E. 17 years

3. Timely detected pulmonary tuberculosis includes:

A. NPTB (01.01.2001) of the middle lobe of the right lung (primary tuberculous complex), Dest+, MBT+M-K+, Resist-, Hist0, Cat1 Cog1(2001)

B. NPTB (02.02.2002) of the upper lobe of the left lung (focal) (infiltration), Dest-, MBT-M-K-, Hist0, Cat3 Cog1(2002)

C. NPTB (03.03.2003) of the left lung (cirrhotic), Dest-, MBT-M-K-, Hist0, Cat1 Cog1(2003)

D. NPTB (04.04.2004) of the upper lobe of the right lung (infiltrative), Dest+, MBT-M-K-, Hist0, Cat1 Cog2(2004)

E. NPTBL (05.05.2003) (disseminated), Dest+, MBT-M-K-, Hist0, Cat1 Cog2(2003).

4. Late-detected pulmonary tuberculosis includes:

A. Newly diagnosed pulmonary tuberculosis (06.06.2002) of the lower lobe of the left lung (Tuberculoma), Dest-, MBT+M-K+, Resist-, Hist0, Cat1 Cog2 (2002)

B. Newly diagnosed pulmonary tuberculosis (07.07.2001), left-sided (pleurisy), MBT-M-K-, Hist0, Cat1 Cog3 (2001)

C. Newly diagnosed pulmonary tuberculosis (10.10.2001) (milliary), Dest-, MBT+M+K+, Resist-, Hist0, Cat1 Cog4 (2001)

D. Newly diagnosed pulmonary tuberculosis (11.11.2002) of the upper lobe of the right lung (infiltrative), Dest+, MBT-M-K-, Hist0, Cat1 Cog4 (2002)

E. Newly diagnosed pulmonary tuberculosis (21.12.2003) of the left lung (fibrocavernous), Dest+, MBT+ M+K+, Resist+ (H, R), Hist0, Cat1 Cog4 (2003).

5. Mass fluorographic screening of the population, starting from the age of 18, is carried out:

A. Every 6 months

B. Once a year

C. Once every two years

D. Once every three years

E. Once every 5 years

6. Patients belonging to the high-risk group for tuberculosis include those with:

A. chronic tonsillitis,

B. Diabetes Mellitus,

C. axillary hernia,

D. hypertensive disease,

E. ascariasis.

7. Under which dispensary registration category should a patient with newly diagnosed pulmonary tuberculosis (01.01.2004) of the upper lobe of the left lung (infiltrative), Dest+, MBT+M+ K+, Resist-, Hist0 be monitored?

A. I

B. II

C. III

D. IV

E. V

8. Patient K., aged 25, died of Fibrocavernous pulmonary tuberculosis, MBT (+). For how long should his family members be monitored at the TB dispensary?

A. 3 months

B. 6 months

C. 12 months

D. 2 years

E. 5 years

9. What is the frequency of prophylactic fluorographic examinations for mandatory screening groups?

A. Once every 6 months

B. Once every 9 months

C. Once per year

D. Once every two years

E. Once every three years

10. Indefinite disability status is established for men and women at the age of, respectively:

A. 45 and 35 years

B. 50 and 40 years

C. 55 and 45 years

D. 60 and 55 years

E. 65 and 60 years

11. A 34-year-old woman was treated for Infiltrative pulmonary tuberculosis 8 years ago. She was discharged with significant improvement. Over the past 6 years, the chest X-ray picture has been stable (an area of pneumosclerosis and two calcifications below the right clavicle). To which dispensary surveillance group should the patient be assigned?

A. 5.1

B. 5.2

C. 5.3

D. 5.4

E. 5.5

12. A 28-year-old teacher, O., underwent treatment for 10 months for infiltrative Tuberculosis of the upper lobe of the right lung, decay phase, MBT (+). Significant improvement was achieved (cessation of bacterioexcretion, closure of the decay cavity). What is the further strategy regarding employment?

A. Allow to return to previous work

B. Extend the sick leave certificate up to 12 months and allow to work

C. Refer to the MSEExpert (MSEC) for establishment of disability group III

D. Refer to the MSEExpert (MSEC) for establishment of disability group II

E. Offer alternative employment

TASKS

1. Patient A., 35 years old, newly diagnosed pulmonary tuberculosis (ВДТБ) (25.10.1999) of the right lung (infiltrative) (dissemination), Dest+, MBT+M+K+, Resist-, HistO, Cat1 Cog4(1999). Contacts: wife and a seven-year-old child.

а) What control measures should be implemented in the tuberculosis focus (foci)?

б) Will you revaccinate the child, and under what conditions?

2. A kindergarten teacher, newly diagnosed pulmonary tuberculosis (ВДГБ) (22.09.2002) of the upper lobe of the right lung (focal), Dest+, MBG+M-K+, Resist-, HistO, Cat1 Cog3(2002).

а) Evaluate the quality of case detection.

б) Management strategy regarding the patient and the children.

3. Patient, newly diagnosed pulmonary tuberculosis (ВДГБЛ) (20.09.2002) (disseminated), Dest+, MBG+M+K+, Resist-, Hist0.

а) Determine the dispensary registration category.

б) How long will the patient be considered a bacterium excretor?

Last update: 10/08/2026

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