Tuberculosis has always been considered a disease suffered by young people who live in difficult conditions. After the war, it decimated society, but thanks to screening tests and compulsory vaccinations, it was brought under control. However, for some time you have heard about the return of this disease. Currently, the main group of patients are mature people. Does this mean tuberculosis is out of control again? Does the lack of screening tests contribute to the disease?

Istuberculosisstill dangerous? Specialists calm down. There is no indication that we are in danger of an epidemic oftuberculosis . In 2010, 7509 cases were registered - it was by 727 cases less than the year before and by 3163 less than ten years ago. There were 6,610 new cases of tuberculosis, and 899 cases were new cases.

Big cities are at risk of tuberculosis

In 2010, as in previous years,pulmonary tuberculosis(6992 people) dominated, which constituted 93.1% of the total population. all illnesses. 517 people developed extrapulmonary tuberculosis. In 43 others, coexistence of extrapulmonary and lung lesions was found. The most common form of extrapulmonary tuberculosis was tuberculous pleurisy (199 cases). Tuberculosis of peripheral lymph nodes (84 patients), tuberculosis of bones and joints (79, including 30 cases of tuberculosis of the spine), and tuberculosis of the genitourinary organs were also diagnosed (74). Tuberculous meningitis and encephalitis were recorded in 8 people. In 2010, there were no cases of tuberculous meningitis in children and adolescents. The mean age of the patients was in the range of 50-54 years. People aged 45-64 were ill most often; more than twice as often men as women. The fact that the age limit has shifted may indicate that the elderly have reactivated the disease they contracted many years ago. Men aged 50-54 are the greatest risk group, which in many cases is associated with alcoholism and homelessness. There is also a fresh transmission of infections in these groups. Children up to the age of 14 accounted for 0.8% of the total population. of all patients - 62 cases were registered, of which 22 were pulmonary tuberculosis and 40 extrapulmonary. The most common form of extrapulmonary tuberculosis in children was tuberculosis of the chest lymph nodes (27cases). A new phenomenon in the epidemiology of tuberculosis in Poland is that inhabitants of large cities get sick more often than inhabitants of rural areas. 4,618 cases were registered in towns and 2,891 in rural areas. In highly developed countries this tendency has been known for a long time.

One in ten will fall ill with tuberculosis

Tuberculosis is not as contagious as measles or smallpox, but it must not be taken lightly. Only 10 percent. who are infected whenever they get sick. The presence of tuberculosis bacilli in the body does not necessarily mean disease, even when tuberculin skin test is positive. The first 2 years are the most dangerous from the moment of infection. With regard to tuberculosis, there is no typical period of hatching. The disease may appear several weeks or several years after infection. Nevertheless, infection occurs through contact with an infected and mycobacterial person. We become infected through close and long-term contact with a sick person. People living together with the sick are the most vulnerable. There is a small risk of infection through normal contact, such as conversation, but this cannot be ruled out, especially if someone is coughing without covering their mouth. When you cough, the most aerosol comes out of your mouth, which may contain bacteria. That is why examining people who are with the patient is so important. It is extremely important to check if they are infected or have active disease. When the concerns about active infection are confirmed, chemoprophylaxis can be applied, i.e. preventing the disease from developing. Chemoprophylaxis stops the infection from becoming active disease. Information about the infection is also important when the patient requires organ transplantation, administration of immunosuppressive drugs, before starting biological treatment, e.g. in rheumatoid arthritis or psoriasis. Why is information about an infection so important? Well, these therapies contribute to the transition of a latent infection into an active form of tuberculosis. HIV infection is the strongest risk factor that a latent tuberculosis infection will turn into active disease. The risk of developing the disease also increases in people suffering from diabetes and kidney failure.

Tuberculosis - how to catch the sick

The dominant method of detecting patients with pulmonary tuberculosis in Poland is the so-called passive detection. It consists in catching people who report to a doctor themselves because of disturbing symptoms. This method was detected in 2010, 88.7 percent. cases of disease. After examining people who had contact with patients, tuberculosis was diagnosed in only 1.5 percent. of them. Many people may be surprised by this method. However, there is no strong evidence that a greater detection of tuberculosis results from an active search for peopleinfected. Some countries with more than Poland funds for he alth care look for patients in high-risk groups, e.g. the homeless. The disease is then detected a bit earlier, but it does not significantly affect the incidence of the society. Besides, WHO recommends the passive search for patients as the most cost-effective. In tuberculosis, a much more serious problem is the general disregard for prolonged and unjustified cough. This problem does not only affect people on the margins of society, but everyone. For the epidemiology of tuberculosis, bacteriological confirmation of the disease is important, i.e. the detection of mycobacteria in the patient's sputum or blood. In 2010, tuberculosis was confirmed bacteriologically in 4,756 patients, including 4,585 cases of pulmonary tuberculosis. Among 517 patients with extrapulmonary tuberculosis, 171 were diagnosed with bacteriological evidence. There were 45 foreigners among the sick. 215 cases of the disease were found among people in arrests and prisons. Each prisoner is tested for tuberculosis. If he is sick, he will be isolated but cannot be forced into treatment.

This will be useful to you

Vaccination program

The first vaccination is done within 24 hours after the baby is born. When there is no post-vaccination scar or it is smaller than 3 mm, the next ones are made at the age of 12, and the next at the age of 7. On the other hand, 12- and 18-year-olds are vaccinated when the tuberculin test is negative.

Are we in danger of an epidemic? Tuberculosis is back!

Important

Koch's Mycobacteria

Mycobacterium tuberculosis is an aerobic bacterium that belongs to the Mycobacteriaceae family and belongs to the group of mycobacteria tuberculosis. It was first identified by the German scientist Robert Koch, who announced his discovery in 1882. The bacterium has the shape of a straight or slightly bent stick with a very small size. Mycobacteria divide slowly, on average every 15-20 hours. They develop inside cells, and as a result of their action, characteristic reactive granulomatous changes called tubercles are formed, hence the name tuberculosis.

Tuberculosis - how does the vaccine protect?

In 2010, 93.4 percent were vaccinated against tuberculosis (BCG vaccination). all newborns. Vaccinating such young children is extremely important because it protects them against the most dangerous forms of tuberculosis, i.e. blood derivatives. Vaccinations reduce the risk of meningitis and miliary disease (a severe, generalized disease). Vaccination effectively protects the child against the most dangerous forms of tuberculosis for the first 2 years. It is different later, becausethe tuberculosis vaccine is not as effective as those given against other infectious diseases. Taking it significantly reduces the risk of falling ill, but does not exclude it.

Important

Obligation to inform

Pursuant to the Act of December 5, 2008, each case of an infectious disease within 24 hours must be reported to the state poviat sanitary inspector competent for the place where the infection or infectious disease was diagnosed, or to the state voivodeship sanitary inspector.

Important in the diagnosis: turberkulin group

This term is widely known, but contrary to popular belief, its use is not used to diagnose tuberculosis. The purpose of the tuberculin test is to diagnose latent or latent infection. However, it does not answer the question of when the infection occurred - 2 months before its taking, when the risk of developing the disease is high, or 20 years earlier, when the risk of developing the disease is low. Even having the vaccine may give you a positive test result. In the case of people who come into contact with the patient, the tuberculin test is more important. The likelihood, but not evidence, of a recent infection is greater. You can then assume that it comes from a sick household member and apply prophylactic chemotherapy to prevent the development of the disease. The tuberculin test is performed by subcutaneous administration of tuberculin. The result is read after 72 hours - a ruler measures the diameter of the infiltrate (induration), not the area of ​​redness. For several years, doctors also have the IGRA test, which is more precise than the tuberculin test because it does not show false-positive results. In other words, if the IGRA test is positive, you have become infected. But the IGRA also does not distinguish between old infection and fresh, and active tuberculosis infection from latent infection. However, it narrows the circle of people who should undergo further diagnostics. The test is carried out with blood.

Problem

Against Europe

In world statistics, Poland is classified as one of the countries with a low incidence of tuberculosis. Unfortunately, compared to Europe, we fare a bit worse. We are far from, for example, Germany, where the incidence is low and amounts to 5 cases of tuberculosis per 100,000. population, or Norway, where in 2010 only 339 patients with bacteriologically confirmed tuberculosis were diagnosed in the whole country. In 2009 (data for 2010 is not yet available), 743 patients died of tuberculosis in Poland, the majority of whom were 65 or more years of age. One child who was diagnosed with tuberculous meningitis and encephalitis also died. In Poland, men died four timesmore often than women.

X-ray examination can be unreliable

Searching for sick people with X-rays does not give good results. For medical reasons, no one will agree to such a test every 3 months. In addition, the X-ray image also shows old, healed lesions in the lungs, which can be confused with fresh tuberculosis outbreaks. Such a person would be unnecessarily exposed to taking anti-tuberculosis medications.

It is good to know how to protect yourself against tuberculosis …

  • Follow basic hygiene rules.
  • Cover your mouth when you cough and call attention to people who don't.
  • Ventilate the rooms you are in frequently.
  • Do not use drastic slimming methods

… and recognize the symptoms of the disease

Initially the disease is asymptomatic, but with time they appear:

  • lack of appetite leading to weight loss,
  • cough, possibly accompanied by expectoration,
  • night sweats,
  • fever,
  • weakness,
  • getting tired quickly,
  • chest pain,
  • shortness of breath.
Important

Tuberculosis treatment

The principles of treating tuberculosis and other infectious diseases are regulated by the provisions of the Act of December 5, 2008. They are in line with the recommendations of the World He alth Organization. Everyone with tuberculosis is en titled to free treatment, whether or not they are insured. The sooner tuberculosis is detected and treatment is started, the better it is for the patient, as there is a chance that the disease will not damage the respiratory system.

  1. In the period of mycobacteria or high risk, the patient must be isolated, but there is no compulsion to undergo treatment. The intensive treatment phase lasts 2 months and during this time the patient should stay in hospital. Standard tuberculosis treatment lasts 6-8 months, and if the patient does not have mycobacteria, further treatment may be continued on an outpatient basis at a lung disease clinic.
  2. Each patient who is hospitalized undergoes a bacteriological examination to confirm the presence of mycobacteria in the sputum, bacterioscopy and bronchoscopy. Bacteriological examination is extremely important in the diagnosis and treatment of tuberculosis. It happens that under the non-specific symptoms of tuberculosis another, dangerous disease hides. In 2010, there were 109 such misdiagnoses. After a bacteriological examination, it turned out that 30 people suffered from lung cancer, and the rest had other respiratory diseases.
  3. Many anti-tuberculosis drugs are used to treat tuberculosis. Usually it is a combination of 3-4 preparations that are selected aftertesting the sensitivity of mycobacteria to various drugs. However, waiting for the test results does not delay treatment. If, based on the symptoms and radiological examination, the doctor is sure that the patient has tuberculosis, he or she recommends taking anti-tuberculosis drugs. Most tuberculosis patients' medications are available immediately. In the case of multi-drug resistant tuberculosis, drugs for the patient are imported as part of the target import. This does not delay the therapy, because hospitals treating tuberculosis have little stocks of these drugs.
  4. The condition for successful therapy is regular medication. If the patient does not do this or takes only a part of them, mycobacterial resistance develops. Then the so-called drugs are administered. second flush, but this often fails. The disease becomes chronic, irreversibly destroys the lungs, and this leads to death. Everyone with tuberculosis is en titled to free treatment, whether or not they are insured. The sooner tuberculosis is detected and treatment is started, the better it is for the patient, as there is a chance that the disease will not damage the respiratory system.

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Infectious diseases