Tuberculosis Study Guide - M. M. Savula 2002

Tuberculosis detection

Tuberculosis is detected in the following main ways:

♦ during routine screening of the population;

♦ through targeted monitoring of high-risk groups for tuberculosis;

♦ when patients present to healthcare professionals with symptoms of the disease.

Timely detection of tuberculosis is a crucial prerequisite for its cure and for preventing the infection of healthy individuals.

To evaluate the quality of respiratory tuberculosis detection, cases are classified as detected timely, untimely, or late.

Timely diagnosed cases include localized, uncomplicated forms of tuberculosis (focal, infiltrative, localized disseminated) without cavity formation or bacterial shedding. The cure rate for patients with these forms reaches 100%. Similar forms of tuberculosis in the destructive phase with bacterial shedding are classified as untimely detected (with cure rates ranging from 65% to 85%). When irreversible fibrotic changes are already forming in the Lungs, these are considered late-detected or advanced forms of tuberculosis. These include fibrocavernous, cirrhotic, and Chronic disseminated Pulmonary Tuberculosis with cavity formation.

Preventive screening of the population. The primary screening method for children is mass or preventive tuberculin Skin testing (see the section "Tuberculin Skin Testing"), while for adults, it is chest photofluorography.

Photofluorographic screening for tuberculosis and other lung diseases covers individuals starting from 15 years of age and is repeated once every 2 years. Stationary (in the photofluorography room of a clinic or TB dispensary) and mobile photofluorographs are used for the examination. Feldsher-midwife station (FAP) workers are responsible for systematic photofluorographic screening of the population in their service area. For this purpose, based on data from the local rural council and door-to-door visits, a card index is created at the FAP for the entire population aged 15 and older. It is regularly updated with cards for newcomers, while cards of those who leave are removed.

In the card index, the so-called "mandatory" or "decreed" cohorts are specifically highlighted and marked, as they must undergo photofluorographic screening more frequently due to The Nature of their profession. They are screened upon employment and subsequently once a year. The regular screening of these individuals is monitored by the Sanitary and epidemiological service.

If active pulmonary tuberculosis (with or without bacterial shedding) or extrapulmonary forms of tuberculosis with fistulas, bacteriuria, or lupus vulgaris of the face or hands are diagnosed, these individuals are restricted from working in certain establishments. This primarily applies to 3 occupational groups.

♦ Individuals in direct contact with children or adolescents. Employees of educational, instructional, medical, recreational, and sports facilities for children and adolescents. Librarians serving children, and individuals involved in manufacturing and selling children's clothing and toys.

People working in maternity hospitals, medical, sanatorium, and educational institutions for infants and preschool children are barred from employment even if they have inactive post-tuberculosis changes in their lungs.

♦ Individuals in contact with food products. Workers in catering units, industrial enterprises, and public food service establishments who are directly involved with raw Materials, semi-finished products, and finished goods during their manufacture, packaging, storage, transportation, and sale; livestock farm and poultry factory workers, Water Treatment plant employees, and food delivery drivers.

♦ Workers in direct contact with large numbers of people. Public and personal service workers (bathhouse attendants, massage therapists, hairdressers, cosmetologists, etc.), swimming pool staff, train conductors, ticket collectors; otorhinolaryngologists, dentists, nurses, and orderly staff, pharmacy and pharmaceutical factory workers involved in manufacturing, packaging, and selling medicines; domestic workers, and dormitory and hotel staff.

Dormitory residents undergo photofluorographic screening upon moving in and annually thereafter; adolescents undergo annual screening during their studies in educational institutions for occupations classified as decreed.

Incarcerated individuals undergo photofluorographic screening once every 6 months.

All adult family members of a newborn child must undergo photofluorographic screening and present a certificate of clearance before the baby is discharged from the maternity hospital.

The feldsher monthly reconciles records of photofluorographic screenings of rural residents with the data from the photofluorography room of the central district hospital and updates their card index. Based on this, FAP staff are required to proactively refer individuals who have missed their scheduled screenings for photofluorography.

If a mass screening using a mobile photofluorograph is planned in a community, the feldsher conducts preliminary health education, explaining Structure/19.html">The Importance of preventive screenings to the population. They participate directly in organizing the photofluorography and ensure timely follow-up examinations for individuals found to have pathological changes in their lungs.

In the intervals between photofluorographic screenings, the feldsher actively identifies patients during door-to-door visits, which are conducted at least 3 times a year. All individuals with symptoms of intoxication, and especially those coughing for more than 3 weeks, are referred for further examination to the district clinic or TB dispensary. For non-transportable patients, sputum should be collected and sent for smear Cell/15.html">Microscopy and culture testing to detect Mycobacterium tuberculosis.

Tuberculosis detection is most effective in high-risk groups, which include: individuals with residual fibrotic and focal changes of any Etiology in the lungs and Pleura, chronic non-specific lung diseases, Diabetes Mellitus, chronic adrenal insufficiency, PEPTIC ULCER DISEASE of The Stomach and duodenum, history of gastric resection, chronic mental illness, occupational dust-induced lung diseases, history of exudative Pleurisy, long-term treatment with immunosuppressive drugs, including glucocorticoids, Radiation therapy, chronic alcoholics, drug addicts, and people living with HIV. All these individuals must undergo annual photofluorographic screening. Pregnant women also have an increased risk of tuberculosis, but unnecessary photofluorographic screening is discouraged for them. However, if a pregnant woman develops persistent symptoms of intoxication, cough, sputum production, wheezing in the lungs, or weight loss, the feldsher must immediately refer her to a doctor for examination. All these high-risk individuals are monitored by general healthcare network staff.

The feldsher in their service area must also be aware of high-risk individuals monitored by phthisiologists. These include contacts of tuberculosis patients, patients who have achieved clinical cure from tuberculosis (examined at the TB dispensary once every 6 months), and individuals with extensive inactive post-tuberculosis Changes in the lungs (examined at the TB dispensary once a year). The feldsher is responsible for ensuring the timely examination of these individuals.

Preventive screenings help detect 50% to 70% of tuberculosis cases, while other patients are diagnosed when seeking medical attention for symptoms of the disease. Therefore, the feldsher must know the key clinical signs and diagnostic Methods of tuberculosis.

The primary reason for delayed tuberculosis Diagnosis is incomplete patient evaluation. Therefore, in all cases of unexplained pulmonary symptoms or intoxication, a simple minimum of diagnostic examinations must be performed, which includes:

- history taking and physical examination;

- complete Blood count and urinalysis;

- chest photofluorography;

- sputum smear microscopy (3 times);

- Mantoux test with 2 TU.

Detection of Extrapulmonary tuberculosis cases

Extrapulmonary tuberculosis is primarily diagnosed when patients present to healthcare providers with Clinical symptoms of the disease. Patients are often treated unsuccessfully for various chronic conditions over an extended period. Therefore, physicians and paramedic-midwife station (FAP) staff must be familiar with the key clinical manifestations that raise suspicion of extrapulmonary tuberculosis in its most common locations.

Bone and joint Tuberculosis.

- intermittent joint or back pain; night pain;

- periodic limitation of motion, limping;

- localized warmth, mild Swelling, and Atrophy of the affected area;

- at later stages: spinal or joint deformity, fistulae, and restricted range of motion.

Particular attention should be paid to patients whose symptoms persist for 2 months or more despite intensive treatment for various musculoskeletal disorders.

Female Genital Tuberculosis.

- menstrual irregularities persisting for over a year despite treatment;

- Infertility with unsuccessful treatment for 2 years;

- refractory chronic inflammation (unrelated to postpartum, post-abortion, or gonorrheal complications), lower abdominal and lower back pain, and discharge.

Renal and Urinary Tract tuberculosis should be suspected in patients who are being unsuccessfully treated for Chronic Pyelonephritis, cystitis, urolithiasis, Renal Colic episodes, radiculitis, or early-onset Hypertension, and who present with the following clinical symptoms:

- malaise, intermittent low-grade fever;

- lower back pain at rest or during physical exertion;

- frequent, painful urination, Hematuria;

- episodes of renal colic;

- abnormal urinary sediment.

Extrapulmonary tuberculosis of various sites is more likely in individuals with active pulmonary, pleural, or other organ tuberculosis, inactive post-tuberculosis lung changes, positive or hyperergic tuberculin skin tests, or a history of contact with infected humans or animals. Therefore, they must undergo the same mandatory minimum diagnostic workup as patients with suspected respiratory tuberculosis and be referred to an appropriate specialist for further evaluation.

Questions

1. What are the Main methods of detecting tuberculosis?

2. What preventive screenings for tuberculosis are conducted among children and adults?

3. At what age and how often is fluorographic screening of the population performed? What are the duties of FAP workers in this work?

4. Which occupational groups are classified as mandated, or mandatory cohorts? What are the Specific features of their fluorographic screenings?

5. Which individuals are classified as high-risk groups for tuberculosis? What are the specific features of their preventive screenings?

6. What is the mandatory minimum of diagnostic examinations performed in individuals with pulmonary changes of unclear nature?

Case Studies

- In your service area, there are patients with the following pathologies: a) diabetes mellitus; b) chronic cholecystitis; c) gastric ulcer; d) rheumatism; e) hypertension.

1. Identify which of these individuals belong to the high-risk group for tuberculosis.

2. How often should they undergo fluorographic screening?

- A 62-year-old retiree with a history of gastric ulcer was diagnosed with Fibrocavitary pulmonary tuberculosis, MTB+, during an outpatient clinic visit. He had previously undergone fluorography 4 years ago, which showed no pulmonary changes.

1. Evaluate the quality of tuberculosis detection (timely, delayed, or late).

2. Does the patient have risk factors for developing tuberculosis?

3. What were the shortcomings of the patient's previous preventive screenings?

- In your service area, there are people working in the following occupations: a) carpenter; b) locksmith; c) milkmaid; d) buffet attendant; e) construction materials warehouse watchman; f) schoolteacher; g) hairdresser; h) painter.

1. Individuals of which of the listed occupations belong to the "mandated" or "mandatory" cohorts?

2. How often do they undergo fluorographic screening?

- A 52-year-old man presented with Complaints of a cough with mucoid sputum production for a month. He noticed blood streaks in his sputum once. He has lost 4 kg, and his body Temperature periodically rises to 37.2-37.6 °C.

1. Which diseases can be suspected?

2. What is the minimum scope of examinations that should be performed for the patient?