TUBERKULOZA PLUĆA - TBC (Tuberculosis pulmonum) PDF Ispis E-mail
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Hronična bakterijska infekcija izazvana bacilom tuberkuloze mycobacterium tuberculosis koju karakteriše stvaranje specifičnih granuloma u inficiranim tkivima, ćelijski uzrokovanom hipersenzitivnošću i nekrotizirajućim promjenama. Najčešće se nalazi na plućima (85%), ali i kod ostalih organa (15%).

Etiologija

Mikobakterija tuberkuloze je bacil, aerob, acidoalkoholo-rezistentan. Zbog imunoloških odbrambenih mehanizama nosioca, pritajeni bacili, iako godinama žive u organizmu nosioca, ne izazivaju bolest, ali ostaju sposobni da se reaktiviraju i da onda uzrokuju progresivnu i po život opasnu bolest - tuberkulozu. Bacila karakteriše sporo razmnožavanje, mogućnost života kao intracelularnog parazita, te mogućnost ostajanja u uspavanom stanju intracelularno u organizmu jako dugo vremena. Prenosi se uglavnom kao kapljična infekcija, a kapljice na vazduhu lako ispare i tako osušeni bacili ostaju dugo u zraku, u mračnom prostoru mogu ostati živi mjesecima bez kontakta sa domaćinom.

Patogeneza

Infekcija sa bacilom tuberkuloze se u većini slučajeva događa samo jednom u životu i to u urbanim područjima uglavnom u djetinjstvu.

Prvi ulazak kod prethodno nezaraženih osoba, bilo u pluća bilo na neko drugo mjesto, dovodi do nespecifične akutne upalne reakcije , koja uglavnom prolazi bez simptoma. Bacil tuberkuloze tada bude fagocitiran od strane makrofaga koji ga prenesu do regionalnih limfnih čvorova (ako se tu ne zaustavi može doći do hematogene diseminacije).

Od dvije do osam sedmica poslje primoinfekcije bacili se razmnožavanju intracelularno u makrofagima, ali u zaraženom domaćinu dolazi do razvoja ćelijske imunosti. Limfociti se nakupljaju na mjestu zaraze i izlučuju interleukine i limfokine koji privlače monocite i pretvaraju ih u makrofage i specijalizirane histiocite koji će stvoriti granulom. Granulomi često kalcificiraju - kombinacija kalcificirane periferne lezije i kalcificiranog limfnog čvora poznata je kao Ghonov komplex.

Kod 90-95% imunokompetentnih osoba dolazi do potpunog zacjeljenja primarnog afekta, a kod onih sa lošim nutricijskim statusom i brojnim drugim faktorima dolazi do inkomopletnog zacjeljenja.

Tuberkulozna bolest javlja se kod malog broja ljudi koji nisu uspješno preboljeli primoinfekciju. Kod nekih se tuberkuloza razvija već za nekoliko sedmica, a kod većine se bacil tuberkuloze uspava tokom mnogo godina.

Životna dob je jako važan faktor koji određuje tok bolesti:

  • dojenčad - tuberkulozna infekcija jako brzo napereduje do bolesti i postoji velik rizik od razvoja diseminirane tuberkuloze, posebno meningitisa,
  • kod djece primarna tuberkuloza gotovo uvjek zacjeljuje,
  • kod odraslih - izloženi su najvećem riziku od razvijanja tuberkulozne promjene unutar 3 godine od početka primarne zaraze.

Primarna tuberkuloza pluća

Nastaje kod prve zaraze mikobakterijama i daje karakteristični primarni komplex (ranke) koji se sastoji od primarnog afekta (Ghonovo žarište - parenhimska lezija u plućima) i uvećanih limfnih čvorova u medijastinumu. Primarni afekt se u roku od oko 8 dana razvija u tipični kazeificirani tuberkulum koji se u povoljnom slučaju resorbira, fibrozira, kalcificira ili osificira. U nepovoljnom slučaju dolazi do kolikvacije, kavernizacije, limfogene i hematogene diseminacije i kanalikularnog širenja.

Primarna tuberkuloza kod odraslih daje mali broj subjektivnih simptoma i fizikalno-dijagnostičkih znakova, osim što se razvija imunitet (alergija) na bacil, a srećemo često i eksudativni pleuritis.

Simptomi

Subjektivni simptomi primarne TBC su nekarakterisitični i prema kliničkoj slici možemo ih podijeliti na:

  • laki oblici - većina je latentna, a mogu se javiti i manifestni znaci (mršavljenje, zamaranje, subfebrilne temperature nakon napora i Erythema nodosum). U nekim slučajevima može se javiti povišena temperatura od 39 o C ili 40 o C, bez drugih simptoma.
  • teški oblici - kada se zbog nepovoljnih uslova infekcija širi, stvara se primarna kaverna, izražene promjene na limfnim čvorovima, primarna kazeozna pneumonija i diseminirana milijarna tuberkuloza, a zbog stenoze, opstrukcije granulacionim tkivom ili kompresije bronha javljaju se segmentalne i lobarne atelektaze. Jako uvećani limfni čvorovi mogu dovesti do dispneje, stridora i cijanoze.

Fizikalna dijagnostika

Prstenasta sjena na radiološkom snimku najčešće se nalazi u sredini ili donjem dijelu pluća i prate je uvećani limfni čvorovi u medijastinumu. Jako uvećani limfni čvorovi kod primarne tuberkuloze mogu dovesti do dispneje, inspiratornog stridora, bitonalnog kašlja, Despineovog znaka i Petruschkyjeve spinalgije. Zbog stenoza i kompresije bronha mogu se javiti atelektaza i lokalizirani emfizem. Bronhoskopija ima važan dijagnostički značaj. Kod malih promjena uglavnom nema znakova.

Objektivna dijagnostika

  • Radiološki pregled - otkriva uvećane limfne čvorove u medijastinumu (što ne nalazimo kod postprimarne tuberkuloze) struktura, prstenasta sjena najčešće u srednjim i donjim dijelovima pluća bi trebala da bude primarni afekt ali se on rijetko vidi. Kalcifikacije kada postoje tada su jasno vidljive i dobro ograničene. Nalaz kod razvijenih primarnih lezija biće opisan poslje
  • Kultura ispljuvka
  • Tuberkulinski test - pozitivna tuberkulinska proba uglavnom odaje zarazu a negativan test čini tuberkuloznu infekciju manje mogućo.

Kazeozna pneumonija - liči na lobarnu, počinje obično naglo sa visokom temperaturom. U prilog da se radi o tbc govori: bolesnik je blijed, profuzno se znoji, cijanotičan je, čini se više intoksiciran, brže mršavi, ima česte hemoptizije. A radiološki nalazimo lobarno zasjenjenje uz promjene na limfnim čvorovima. Pozitivna kultura i pozitivna tuberkulinska proba.

Terapija

Najveći broj primarnih infekcija se ne otkrije i ne liječi, a teški oblici se liječe kao i svaka druga tuberkuloza.

Komentari (135)
  • vildana
    molimvas da mi objasnite šta znaci bijopsija plucne maramice. kakve mogu ocekivati prognoze mama mi lezi na klinici posrastovi doktoru se nesvica voda koja je crvenkasta šta mogu ocekivati nalaz je u cetvrtak.
  • Anoniman  - re:
    vildana napisao:
    molimvas da mi objasnite šta znaci bijopsija plucne maramice. kakve mogu ocekivati prognoze mama mi lezi na klinici posrastovi doktoru se nesvica voda koja je crvenkasta šta mogu ocekivati nalaz je u cetvrtak.
  • vildana  - pluca
    molim vas da mi objasnite šta znaci bijopsija plucne maramice.
  • vildana  - re: re:
    Anoniman napisao:
    [quote=vildana ]molimvas da mi objasnite šta znaci bijopsija plucne maramice. kakve mogu ocekivati prognoze mama mi lezi na klinici posrastovi doktoru se nesvica voda koja je crvenkasta šta mogu ocekivati nalaz je u cetvrtak.
    [/quote]
    Anoniman napisao:
    [quote=vildana ]molimvas da mi objasnite šta znaci bijopsija plucne maramice. kakve mogu ocekivati prognoze mama mi lezi na klinici posrastovi doktoru se nesvica voda koja je crvenkasta šta mogu ocekivati nalaz je u cetvrtak.
    [/quote]
  • Anoniman
    Biopsija pluća se vrši radi uzimanja uzorka tkiva za analizu i uspostavljanje tačne dijagnoze, a može se obaviti izvana, iglom, uz CT navođenje. Otvorena biopsija pluća podrazumijeva operacijski zahvat otvaranja prsnog koša i uzimanja tkiva.
  • Dario Panella  - fizicka aktivnost djece oboljelih od latentne TBC-
    Molim da mi detaljnije pojasnite koja bi bila adekvatna fizicka aktivnost za dijete od 12 godina oboljeno od latentne TBC-e: djecak je na izgled zdrav, nema nikakovih simptoma osm +PPD-a: Trenutno je na terapiji nakond 2 tjednog boravka u bolnici: Ispljuvak je jos na analizi: Djecak je dobre fizicke gradje ali nezainteresiran z a bilo koji oblik tjelovjezbe glede pogresnoe recepcije Doktorove poruke da se ne treba umarati:

    Unaprijed zahvalan

    tata
  • Dario Panella  - re: fizicka aktivnost djece oboljelih od latentne
    Dario Panella napisao:
    Molim da mi detaljnije pojasnite koja bi bila adekvatna fizicka aktivnost za dijete od 12 godina oboljeno od latentne TBC-e: djecak je na izgled zdrav, nema nikakovih simptoma osm +PPD-a: Trenutno je na terapiji nakond 2 tjednog boravka u bolnici: Ispljuvak je jos na analizi: Djecak je dobre fizicke gradje ali nezainteresiran z a bilo koji oblik tjelovjezbe glede pogresnoe recepcije Doktorove poruke da se ne treba umarati:

    Unaprijed zahvalan

    tata
  • Vladimir Arbutina  - Tuberkuloza ili ne ?!
    Molim vas za kratak odgovor . Nauime nalazim se u Norveskoj gde mi je na tuberkuloznom testu koze otkriveno da mozda imam tuberkulozu . Nalaz je bio na granici ( 15mm). Posle toga su me uputili na analizu krvi i rengen . Rengen je negativan , analiza krvi pokazuje prisutne bacile TBC . Jedan moj prijatelj , lekar mi je rekao da je to normalno ,dok ovde sumnjaju da sam zarazen. Moje pitanje je da li je moguce da su te pozitivni rezultati posledica vakcinacije ( imam 38god )?! Inace nemam nikakve simptome , amaterski se bavim sportom i fizicki sam zdrav.
    Unared hvala na pomoci !
  • Anoniman
    da li tuberkuloza prelazna za ostale členove porodice
    hvala unaprijed
  • selma
    Da tuberkuloza je prelazna.Ja imam 19god.i imam tubrekulozu i moram paziti da ne zarazim svoju porodicu.
  • Anoniman
    pa imam ija tuberkolozu to jest tbc bijo sam u bolnici kpb tbc slavinovići tuzla nije to ništa opasno to je izlječiva bolest glavne tablete su turbekolotic i nizoni
  • zeljden
    POŠTOVANJE!
    Želim takođe postaviti jedno pitanje u vezi problema koji je vezan za dijagnozu i terapiranje TBC pluća.Moja supruga se lijeći od momenta diagnosticiranja ove bolesti i sada je vec prošlo puna 3 mijeseca, navodno uspješno.Nešto što ne mogu da razumijem jeste da ona još uvjek ima temperaturu koja se kreće između 37 i 38 stupnjeva, pri njenom mijerenju u uhu.Taj isti način mijerenja kod mene pokazuje 36,6. Želim da znam da li je to stvarno normalno kako mi neki lječnici govore ili je to više da bi me utješili.Puno zahvaljujem!
  • Anoniman
    Molim vas da mi objasnite postupak i tok otvorene plućen biopsije kod nas u sarajevu (radi li se pod općom anestezijom, je li to 1 ili više rezova, je li između rebara leđa ili prsa, postoje li neke kontraindikacije za ovaj zahvat, kakva je priprema za zahvat, koliko traje itd.
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  • Zabrinuti  - re:
    Molim vas bolujem od zatvorene tuberhuloze lijecim se mjesec i pol dana dobio sam cetiri kile ali me zabrinjava zasto me samo navecer bole ramena i noge dali zbog toga sto se puno nekrecem ili je nesta drugo
  • Zabrinuti
    Zanima me lijecim se od zatvorene tuberhuloze mjesec i pol pijem lijekove dobio sam cetiri kile to je dobro ali me zabrinjavju bolovi u stopalima i ramenima samo navecer dali je to od nedovoljno kretanja ilije vezano za tbc
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