Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?
The disease caused by Mycobacterium tuberculosis is considered one of the most dangerous to human life and health. It can be localized in various parts of the body and easily transmitted to others.
Therefore, an important direction in medicine is to identify the disease in the early stages and treat it.
One of the ways to bring this idea to life is through groups of dispensary records for tuberculosis, the features of which are worth considering in more detail.
In order to stop the rapid spread of tuberculosis, various forms of screening of children and adults were introduced. These include fluorography and the manta ray test.
If there is the slightest suspicion of the presence of mycobacteria, the patient is referred for a more thorough diagnosis. And if the fear is confirmed, the patient is prescribed treatment. In this case, the dispensary registration group is immediately determined.
This is done for the following purposes:
- control of the number of people infected with tuberculosis;
- combating the further spread of this disease;
- definition optimal treatment for individuals depending on their membership in a particular group;
- determining the effectiveness of the therapy used;
- prevention of re-infection;
- identification of recovered people for further deregistration.
The main institution coordinating other medical organizations in this area is the anti-tuberculosis dispensary. Such structures are created at the rate of 1 per 200,000 people.
Carrying out primary diagnostics, doctors at city and rural clinics and paramedics at first-aid posts send here reports on the work done. Adults and children who are suspected of being infected with tuberculosis are referred to the same organization.
If signs of illness are detected, this body is authorized to issue appropriate documents that guarantee the person the retention of a job or other state support in case of loss of ability to work.
It is worth remembering that diagnosis and seeking medical help is a matter of personal choice. However, registration and appointment of a dispensary observation group do not depend on the desire of the person.
Moreover, if it is known for certain that a person is infected with these dangerous mycobacteria, but does not take any action for treatment, a decision may be made regarding him for forced medical examination.
What is the basis of division into groups?
Dispensary registration groups are formed for tuberculosis, taking into account a number of factors. It depends on the form of manifestation of the disease. Thus, the destructive effect of the disease has not yet manifested itself clearly.
The possible presence of a virus is indicated only by the results of a mantoux test or fluorography. This condition is called tuberculosis of doubtful activity.
Other actions are required if the disease has manifested itself as obvious inflammatory process in the respiratory organs. Being infected initially or repeatedly, a person can easily transmit the source of the disease.
Therefore, he poses a danger to everyone who comes into contact with him. Moreover, until the disease is in active state did not cause complications, clinical cure is still possible.
The development of chronic pulmonary tuberculosis can be a consequence of late diagnosis or lack of systematic treatment. IN in this case The task of doctors will not be to cope with the disease, but to stabilize the patient’s condition during periods of exacerbation.
Since doctors are trying to prevent the spread of a deadly infection, risk groups are identified separately. They consist of people who could potentially become infected.
Although the most common localization of bacteria is in the lungs, they can also be located in other organs. Therefore, rare forms of tuberculosis require specific treatment methods.
These reasons prompt workers of anti-tuberculosis institutions to divide the entire contingent of their patients into 8 groups. Their numbering starts from zero and ends at number 7. Within each of the groups there are also their own divisions.
Group of persons from 0 to 3
Everyone who receives a referral from their attending physician to visit a dispensary is automatically enrolled in the zero group. It includes 2 directions.
The task of the first of them is to identify the onset of the inflammatory process caused by mycobacteria. The second direction involves an expanded set diagnostic methods, allowing you to more accurately determine the organ affected by the disease.
The result of the examination will be either the exclusion of the person from the risk group. Or identifying the disease, its course and location. Based on the data obtained, a group will be assigned and appropriate therapy will be prescribed.
The following two groups of dispensary records are divided into active and chronic tuberculosis. The first of them is divided into categories A and B.
One of them determines the disease in its primary form. And the other serves as an indicator of a relapse. Representatives of both subgroups will be divided according to the presence or absence of bacterial excretion. Separately, in the first group, patients were identified who intentionally interrupted treatment with consequences unknown to health workers.
If tuberculosis manifests itself in one of the active forms, the patient is subject to a number of instructions: x-rays every two months, and sputum culture once every 2-3 months. Over time, the frequency of studies decreases: for group A this occurs when the release of bacteria into the atmosphere stops. And for category B, when the symptoms of an exacerbation begin to go away.
Group 2, which involves diagnosing a chronic type of disease, is also divided into categories. If representatives of subgroup A still have a chance to be cured of their illness, then in category B there are people whose condition can be maintained in a satisfactory condition without a chance of full recovery. Everyone in this group requires x-rays and bacterial cultures once a quarter.
People who benefit from medical examination automatically move to group 3. This category of patients has a double meaning. On the one hand, these are clinically healthy people.
On the other hand, the third group assumes that a new manifestation of tuberculosis symptoms will be perceived as a relapse and appropriate measures will be taken. These people are diagnosed every six months.
Who is included in groups 4-7
Group 4 was created for preventive purposes. It includes those who are in direct contact with infected people. First of all, these are all medical personnel not only in the dispensary, but also in ordinary clinics.
Secondly, this includes immediate relatives and people living in the same house who may be infected due to household contact. Health checks by fluorography every six months are so far the only method of protecting them.
Since the disease can affect not only the lungs, group 5 tuberculosis in dispensary registration suggests its localization in other parts of the human body.
The sixth category has become widespread in the treatment of children. If the reaction gave a mantoux positive result for bacteria, the child is registered in this group and monitoring of his condition continues. If the primary diagnosis is not confirmed, a deregistration procedure occurs.
If there is no positive result, the child is transferred to group 0 for a more accurate medical report. If after treatment the patient exhibits residual effects, he is transferred to group 7.
Let's summarize: since tuberculosis is recognized dangerous disease, its treatment requires a certain system, which currently involves division into 8 categories. A person’s condition and his chances of recovery are determined by belonging to one or another group.
Instructions for organizing dispensary observation and recording of contingents of anti-tuberculosis institutions
I. Groups of dispensary observation and registration of adult contingents of anti-tuberculosis institutions
1.1. Zero group - (0)
In the zero group, individuals with unspecified activity of the tuberculosis process and those in need of differential diagnosis are observed in order to establish a diagnosis of tuberculosis of any localization. Persons in whom it is necessary to clarify the activity of tuberculous changes are included in the zero-A subgroup (0-A). For the differential diagnosis of tuberculosis and other diseases, persons are included in the zero-B subgroup (0-B).
1.2. First group - (I)
In the first group, patients with active forms of tuberculosis of any localization are observed. There are 2 subgroups:
first-A (I-A) - patients with newly diagnosed disease;
first-B (I-B) - with relapse of tuberculosis.
Both subgroups include patients with bacterial excretion (I-A-MBT+, I-B-MBT+) and without bacterial excretion (I-A-MBT-, I-B-MBT-).
Additionally, patients are identified (subgroup I-B) who interrupted treatment or were not examined at the end of the course of treatment (the result of their treatment is unknown).
1.3. Second group - (II)
In the second group, patients with active forms of tuberculosis of any location with a chronic course of the disease are observed. It includes two subgroups:
second-A (II-A) - patients in whom clinical cure can be achieved as a result of intensive treatment;
second-B (II-B) - patients with an advanced process, whose cure cannot be achieved by any methods and who need general strengthening, symptomatic treatment and periodic (if indicated) anti-tuberculosis therapy.
The patient is transferred (enrolled) into II-A or II-B subgroups based on the conclusion of the CVCC (CEC), taking into account the individual characteristics of the course of the tuberculosis process and the patient’s condition.
Arriving patients with active tuberculosis are included in a dispensary observation group appropriate for their condition.
1.4. Third group - (III)
The third group (control) includes persons cured of tuberculosis of any localization with large and small residual changes or without residual changes.
Within the framework of groups I, II and III of dispensary observation and registration, patients with respiratory tuberculosis (RTT) and extrapulmonary tuberculosis (EPT) are identified.
1.5. Fourth group - (IV)
The fourth group takes into account persons in contact with sources of tuberculosis infection. It is divided into two subgroups:
fourth-A (IV-A) - for persons who have household and work contact with the source of infection;
fourth-B (IV-B) - for persons who have professional contact with the source of infection.
II. Some issues of tactics of dispensary observation and recording
2.1. Determination of the activity of the tuberculosis process
1. Tuberculosis of doubtful activity
This concept refers to tuberculous changes in the lungs and other organs, the activity of which seems unclear. To clarify the activity of the tuberculosis process, a 0-A subgroup of dispensary observation was allocated, the purpose of which is to carry out a set of diagnostic measures.
Persons registered in groups III and IV who have a need to determine the activity of existing changes are not transferred to the “0” group. All issues are resolved during their examination and observation in the same accounting group.
The main set of diagnostic measures is carried out within 2-3 weeks. If test therapy is necessary, the diagnostic period should not exceed 3 months.
From the zero group, patients can be transferred to the first or sent to treatment and preventive institutions of the general network.
2. Active tuberculosis
A specific inflammatory process caused by Mycobacterium tuberculosis (MBT) and determined by a complex of clinical, laboratory and radiation (x-ray) signs.
Patients with an active form of tuberculosis need therapeutic, diagnostic, anti-epidemic, rehabilitation and social measures.
All patients with active tuberculosis, diagnosed for the first time or with relapse of tuberculosis, are enrolled only in Group I of dispensary observation. Their registration in group II is not allowed.
If, during surgical intervention, signs of an active tuberculosis process were found in a patient in the third group, then he is left in the third group and undergoes anti-tuberculosis therapy for up to 6 months.
The issue of registering newly diagnosed tuberculosis patients and removing them from this registration is decided by the Central VKKK (KEC) on the recommendation of a phthisiatrician or other specialist of an anti-tuberculosis institution (tuberculosis department). The anti-tuberculosis institution notifies the patient in writing about being placed under dispensary observation and about termination of observation (Appendices No. 1 and ). The dates of notification are recorded in a special journal.
3. Chronic course of active forms of tuberculosis
Long-term (more than 2 years), incl. wave-like (with alternating subsidence and exacerbation) course of the disease, in which clinical, radiological and bacteriological signs of activity of the tuberculosis process remain.
The chronic course of active forms of tuberculosis occurs due to late detection of the disease, inadequate and unsystematic treatment, characteristics of the body's immune state, or the presence of concomitant diseases that complicate the course of tuberculosis.
From subgroup II-A, the patient can be transferred to group III or subgroup II-B.
4. Clinical cure
The disappearance of all signs of the active tuberculosis process as a result of the main course of complex treatment.
The statement of clinical cure of tuberculosis and the moment of completion of an effective course of complex treatment are determined by the absence of positive dynamics of signs of the tuberculosis process within 2-3 months.
The observation period in group I should not exceed 24 months. including 6 months after effective surgery. From group I, the patient can be transferred to group III or II.
2.2. Bacteria eliminators
Patients with an active form of tuberculosis in whom MBT was found in the biological fluids of the body released into the external environment and/or pathological material. Among patients with extrapulmonary forms of tuberculosis, those who have MBT are found in the discharge of fistulas, urine, menstrual blood or secretions of other organs are classified as bacteria-excreting patients. Patients whose MBT were isolated during culture of puncture, biopsy or surgical material are not counted as bacteria excretors.
Multidrug resistance of MTB is their resistance to the action of isoniazid and rifampicin simultaneously, with or without resistance to any other anti-tuberculosis drugs.
Polyresistance is the resistance of MBT to any two or more anti-tuberculosis drugs without simultaneous resistance to isoniazid and rifampicin.
If there are clinical and radiological data on the activity of the tuberculosis process, the patient is registered as a bacterial excretor even with a single detection of MBT. In the absence of clinical and radiological signs of an active tuberculosis process, in order to register a patient as a bacterial excretor, a double detection of MBT by any method of microbiological examination is necessary. In this case, the source of bacterial excretion may be endobronchitis, a breakthrough of a caseous lymph node into the lumen of the bronchus, or the disintegration of a small lesion that is difficult to detect by x-ray, etc.
A single detection of MBT in group III contingents in the absence of clinical and radiological symptoms confirming the reactivation of tuberculosis requires the use of in-depth clinical, radiation, laboratory and instrumental examination methods in order to establish the source of bacterial excretion and the presence or absence of active tuberculosis.
In order to establish bacterial excretion in each patient with tuberculosis, before treatment, sputum (bronchial lavage water) and other pathological discharge must be carefully examined at least three times by bacterioscopy and culture. The examination is repeated monthly during treatment until the MBT disappears, which must subsequently be confirmed by at least two consecutive studies (bacterioscopic + cultural) at intervals of 2-3 months.
An epidemic focus (synonymous with a “focus of an infectious disease”) is the location of the source of infection and the surrounding area within which the infectious agent can spread. Those communicating with the source of infection are considered to be persons in contact with the bacterial pathogen. The epidemic focus is taken into account according to the place of actual residence of the patient. Anti-tuberculosis institutions (departments, offices) are a hotbed of tuberculosis infection. On this basis, employees of anti-tuberculosis institutions are classified as persons in contact with bacteria-releasing agents and are included in the fourth group of dispensary observation.
2.3. Termination of bacterial excretion (synonymous with “abacillation”)
Disappearance of MBT from biological fluids and pathological discharge from the patient’s organs, released into the external environment. Confirmation is required by two negative sequential bacterioscopy and culture (culture) studies with an interval of 2-3 months after the first negative test. A negative result of a bacterioscopic examination is the basis for stating the cessation of bacterial excretion only in cases where MBT were determined by microscopy of diagnostic material and did not grow when inoculated on nutrient media.
When destructive tuberculosis results in filled or sanitized cavities (including after thoracoplasty and cavernotomy), patients are removed from the epidemiological register 1 year after the disappearance of the MBT after 2 microbiological examinations with an interval of 2 months. At the same time, against the background of stabilization of the clinical and radiological picture, MBT should not be detected by microscopy and culture.
The decision to register bacteria excretors and remove them from this registration is made by the Central VKKK (KEC) on the recommendation of a phthisiatrician or another doctor - a specialist in an anti-tuberculosis institution with the sending of a corresponding notice to the center of state sanitary and epidemiological surveillance (TSGSEN).
2.4. Residual post-tuberculosis changes
Residual changes include dense calcified foci and foci of various sizes, fibrous and cirrhotic changes (including residual sanitized cavities), pleural layers, postoperative changes in the lungs, pleura and other organs and tissues, as well as functional abnormalities after clinical cure. Single (up to 3) small (up to 1 cm), dense and calcified lesions, limited fibrosis (within 2 segments) are regarded as minor residual changes. All other residual changes are considered major.
2.5. Destructive tuberculosis
An active form of the tuberculosis process with the presence of tissue decay, determined by a complex of radiation research methods.
The main method for identifying destructive changes in organs and tissues is radiation examination (x-ray - survey radiographs, tomograms). For tuberculosis of the genitourinary organs, it is of great importance ultrasonography. With active tuberculosis process X-ray studies carried out at least once every 2 months (in subgroups I-A, I-B and II-A) until clinical cure, in subgroup II-B - according to indications. The closure (healing) of the decay cavity is considered to be its disappearance, confirmed by radiological diagnostic methods.
2.6. Exacerbation (progression)
The appearance of new signs of an active tuberculosis process after a period of improvement or increased signs of the disease during observation in groups I and II until the diagnosis of clinical cure. In case of exacerbation (progression), patients are taken into account in the same dispensary registration groups in which observation was carried out (groups I and II). The occurrence of an exacerbation indicates ineffective treatment and requires its correction.
2.7. Relapse
The appearance of signs of active tuberculosis in persons who previously had tuberculosis and were cured of it, observed in group III or removed from the register due to recovery.
The appearance of signs of active tuberculosis in spontaneously recovered persons who were not previously registered with anti-tuberculosis institutions is regarded as a new disease.
2.8. The main course of treatment for patients with tuberculosis
A set of therapeutic measures, including an intensive phase and a continuation phase, to achieve clinical cure of the active tuberculosis process.
The duration of the main course of treatment for a patient with tuberculosis is determined by the nature and pace of involution of the process - the timing of the disappearance of signs of active tuberculosis or the statement of ineffectiveness of treatment with the need to correct treatment tactics.
The main method of treatment is combination chemotherapy - the simultaneous administration of several anti-tuberculosis drugs to the patient. medicines according to standard schemes with individual correction. If indicated, use surgical methods treatment.
2.9. Aggravating factors
Factors that contribute to a decrease in immunity to tuberculosis infection, aggravation of the course of tuberculosis and a delay in recovery:
Medical (various non-tuberculosis diseases and pathological conditions);
Social (income below the subsistence level, increased work load, stress);
Professional (constant contact with sources of tuberculosis infection).
Aggravating factors are taken into account when monitoring patients in accounting groups, when determining the timing of treatment and carrying out preventive measures.
2.10. Formulation of diagnosis
When registering an identified patient with active tuberculosis (group I), the diagnosis is formulated in the following sequence: clinical form of tuberculosis, localization, phase, bacterial excretion.
For example:
Infiltrative tuberculosis of the upper lobe of the right lung (S1, S2) in the phase of disintegration and seeding, MBT+.
Tuberculous spondylitis thoracic spine with destruction of vertebral bodies Th 8-9, MBT-.
Cavernous tuberculosis of the right kidney, MBT+,
When transferring a patient to group II (patients with chronic tuberculosis), indicate the clinical form of tuberculosis that currently occurs.
Example. At the time of registration, there was an infiltrative form of tuberculosis. With an unfavorable course of the disease, fibrous-cavernous pulmonary tuberculosis has formed (or a large tuberculoma persists with or without decay). The translated epicrisis must indicate the diagnosis of fibrous-cavernous pulmonary tuberculosis (or tuberculoma).
When transferring a patient to the control group (III), the diagnosis is formulated according to the following principle: clinical cure of one or another form of tuberculosis (the most severe diagnosis for the period of illness is given) with the presence of residual post-tuberculosis changes (major, minor) in the form of (indicate the nature and prevalence of changes , nature of residual changes).
Clinical cure of focal pulmonary tuberculosis with the presence of small residual post-tuberculosis changes in the form of single small, dense foci and limited fibrosis in the upper lobe of the left lung.
Clinical cure of disseminated pulmonary tuberculosis with the presence of large residual post-tuberculosis changes in the form of numerous dense small foci and widespread fibrosis in the upper lobes of the lungs.
Clinical cure of pulmonary tuberculoma with the presence of large residual changes in the form of scars and pleural thickenings after minor resection (S1, S2) of the right lung.
In patients with extrapulmonary tuberculosis, diagnoses are formulated according to the same principle.
Clinical cure of tuberculous coxitis on the right with partial dysfunction of the joint.
Clinical cure of tuberculous gonitis on the left with outcome in ankylosis.
Clinical cure of tuberculous gonitis on the right with residual changes after surgery - ankylosis of the joint.
Clinical cure of cavernous tuberculosis of the right kidney.
The procedure for dispensary observation and recording of adult patients is presented in Table 1.
Table 1
The procedure for dispensary observation and registration of contingents of adults registered with anti-tuberculosis institutions
| Group/ subgr- ppa accounting |
Characteristic contingents |
Periodicity doctor visits sick or sick doctor |
Observation period in the accounting group |
Treatment and diagnostic cues and preventive Events |
Criteria efficiency dispensary observations |
| 1 | 2 | 3 | 4 | 5 | 6 |
| Zero group | |||||
| 0-A | Faces, in need of definition activity tuberculosis process. |
Determined methodology diagnostics |
No more than 3 months. |
Complex diagnostic methods, according to indications - trial chemotherapy. |
Establishment diagnosis. |
| 0-B | Faces, in need of carrying out differential But- diagnostic events. |
Determined methodology diagnostics |
2-3 weeks | Complex diagnostic events |
Establishment diagnosis. |
| I-A | I-A (MBT+) first identified patients with bacteria excretion niya I-A (MBT-) first identified patients without bacteria excretion nia |
At outpatient treatment -daily, at intermittently general treatment - 3 once a week V exceptional cases - 1 time in 7-10 days. |
Determined duration main course treatment, but not more than 24 months from the moment of taking registered |
Main course treatment, with availability indications - surgical treatment, sanatorium treatment. Events for social and labor rehabilitation. Sanitary health and preventive events in foci of infection. |
Achievement clinical cures and transfer to III accounting group 85% of patients after effective main course treatment, but not later 24 months from moment of taking for registration. Transfer of patients to group II - no more than 10% number I groups. |
| I-B | 1-B (MBT+) patients with relapse with bacteria excretion niem 1-B (MBT-) patients with relapse without bacteria excretion nia |
||||
| I-B | Sick, without permission interrupted treatment and evaded examinations. |
- | Transfer of patients to I-B group produced through 1 month after loss of contact. Duration of stay - before resumption treatment or receiving reliable information about the fate of the patient (death, translation, departure). |
Individual working with the patient. If necessary - organization mandatory examinations and treatment according to Article 10 of the Federal law. |
Number of patients in I-B subgroup shouldn't exceed 5% number all first groups! |
| 1 | 2 | 3 | 4 | 5 | 6 |
| II-A | Sick, intense treatment of which may cause to cure tuberculosis. |
Determined condition patient and carried out treatment |
Duration observations are not limited |
Individualized comprehensive chemotherapy taking into account medicinal MBT sensitivity, surgical and sanatorium treatment, additional health Events, raising effectiveness of treatment. Preventive events in the outbreak tuberculosis infections |
Achievement clinical cure tuberculosis 15% annually patients after transfer to II-A subgroup. |
| II-B | Sick, in need of strengthening- shem, symptomatic com treatment and at emergence indications - in anti-tuberculosis beneficial therapy |
Determined condition patient and carried out treatment |
Duration observations are not limited |
Medicinal Events, prolonging life. Surgical and sanatorium treatment - according to indications. Preventive events in the outbreak tuberculosis infections |
Increase duration the lives of the sick, decrease distribution tuberculosis infections due to anti-epidemic chesk and preventive work in the hearth. |
| 1 | 2 | 3 | 4 | 5 | 6 |
| Third group (cured patients) | |||||
| III | Persons with inactive tuberculosis process after clinical cure |
At least 1 time at 6 months. IN period carrying out anti-relapse nal courses treatment - in depending on their methods carrying out. |
Faces with big or small residual changes with availability aggravating factors - 3 of the year. Persons with small residual changes without aggravating factors - 2 of the year. Faces without residual changes - 1 year. |
Complex examination patients are not less than 1 time in 6 months (by indications - more often). Carrying out anti-relapse courses anti-relapse chemotherapy courses according to indications. |
In clinical well-being - removal from the register and translation under observation clinics general medical local networks residence with subsequent carrying out medical inspections 2 times per year for 3 years after deregistration. Relapse tuberculosis - no more than 0,5% average annual number of persons observed in III group in reporting year. |
| 1 | 2 | 3 | 4 | 5 | 6 |
| Fourth group (contacts) | |||||
| IV-A | Persons consisting in household (related, apartment) and production no contact with sick active form tuberculosis with established or unidentified bacteria excretion nim. |
Once every 6 months upon contact with bacteria excreted by telephone and 1 time per year at contact with sick active form tuberculosis without established bacteria excretion nia. |
Duration observations determine cure period patient plus 1 a year after termination contact with bacteria excreted telecom |
Complex examination 2 once a year. IN first year after identifying the source infections according to indications conduct a course |
General morbidity contact persons in bacillary foci - not more than 0.25% of average annual number |
| IV-B | Persons having professional contact with source infections: workers anti-tuberculosis useful (tuberculosis) institutions, workers disadvantaged in a relationship tuberculosis livestock and birds, farms and persons having constant contact with source infections. |
At least 1 time at 6 months. |
Determined period of work in conditions professionally- th contact plus 1 year after it termination. |
Complex examination 2 times a day year: first time - |
Morbidity tuberculosis persons from professional contact - no more than 0.25% of average annual numbers. |
table 2
Scheme of examination of adult patients registered at the dispensary
| Group/ subgroup accounting |
Radiation research methods | Bacterial excretion studies |
| 1 | 2 | 3 |
| 0 (zero) |
X-rays, tomograms, Ultrasound (for tuberculosis genitourinary organs) before enrollment in a group in the future at least once every month (according to indications - more often). |
Bacterioscopy (simple, luminescent), sowing before enrollment in a group monthly thereafter. |
| I-A, I-B, II-A |
Patients with tuberculosis respiratory organs During the course chemotherapy: - in the intensive phase - not less than once every 2 months; - before the decision to transfer to the continuation phase; - in the continuation phase - by indications. - before completing the course treatment; Upon completion of the course chemotherapy - according to indications, but at least 1 once every 6 months Patients with extrapulmonary tuberculosis. According to indications, but at least 1 once every 6 months |
During a course of chemotherapy: - in the intensive phase - at least 1 once a month; - before deciding to move to continuation phase; - in the continuation phase - at the end her second month and beyond according to indications; - before completing the course treatment. Upon completion of chemotherapy - according to indications, but not less than 1 once every 6 months |
| II-B | According to indications, but at least 1 once every 6 months |
According to indications, but at least 1 time at 6 months |
| III, IV | X-rays before enrollment in the accounting group (tomograms - according to indications). In the future - at least 1 once every 6 months, according to indications more often |
Examination of sputum, urine or other diagnostic material) before enrollment group. In the future - at least 1 time per 6 months, more often if indicated |
Notes
Blood, urine and other tests laboratory research(according to indications) are performed for patients of group 0 and patients I-A, I-B and II-A subgroups in the intensive phase of chemotherapy at least once a month, in the continuation phase - at least once every 3 months, patients of the II-B subgroup - once every 6 months (more often according to indications), persons from groups III and IV - once every 6 months
Additional studies required during chemotherapy are defined in the relevant instructions (Appendix 8 to this Order).
All patients with pyuria, hematuria and albuminuria undergo three urine tests for MBT.
III. Groups for dispensary observation and registration of children and adolescents in anti-tuberculosis institutions
3.1. Zero group - (0)
In the zero group, children and adolescents are observed who were sent to clarify the nature of positive sensitivity to tuberculin and/or to carry out differential diagnostic measures in order to confirm or exclude tuberculosis of any localization.
3.2. First group - (I)
In the first group, patients with active forms of tuberculosis of any localization are observed, distinguishing 2 subgroups:
first-A (I-A) - patients with widespread and complicated tuberculosis;
first-B (I-B) - patients with minor and uncomplicated forms of tuberculosis.
3.3. Second group - (II)
In the second group, patients with active forms of tuberculosis of any location with a chronic course of the disease are observed. Patients can be observed in this group with continued treatment (including individual treatment) for more than 24 months.
3.4. Third group - (III)
The third group takes into account children and adolescents at risk of relapse of tuberculosis of any location. It includes 2 subgroups:
third-A (III-A) - newly diagnosed patients with residual post-tuberculosis changes;
third-B (III-B) - persons transferred from groups I and II, as well as subgroup III-A.
3.5. Fourth group - (IV)
The fourth group takes into account children and adolescents who are in contact with sources of tuberculosis infection. It is divided into 2 subgroups:
fourth-A (IV-A) - persons from family, related and residential contacts with bacteria-excreting individuals, as well as from contacts with bacterial excretors in children's and adolescent institutions; children and adolescents living on the territory of tuberculosis institutions;
fourth-B (IV-B) - persons from contacts with patients with active tuberculosis without bacterial excretion; from families of livestock farmers working on farms affected by tuberculosis, as well as from families with farm animals sick with tuberculosis.
3.6. Fifth group - (V)
In the fifth group, children and adolescents with complications after anti-tuberculosis vaccinations are observed. There are 3 subgroups:
fifth-A (V-A) - patients with generalized and widespread lesions;
fifth-B (V-B) - patients with local and limited lesions;
fifth-B (V-B) - persons with inactive local complications, both newly identified and transferred from groups V-A and V-B.
3.7. Sixth group - (VI)
In the sixth group, individuals with an increased risk of local tuberculosis are observed. It includes 3 subgroups:
sixth-A (VI-A) - children and adolescents in the early period of primary tuberculosis infection (tuberculin reactions);
sixth-B (VI-B) - previously infected children and adolescents with a hyperergic reaction to tuberculin;
sixth-B (VI-B) - children and adolescents with increasing tuberculin sensitivity.
The procedure for dispensary observation and registration of children and adolescents in anti-tuberculosis institutions is presented in Table. 3.
Table 3
The procedure for dispensary observation of contingents of children and adolescents registered with anti-tuberculosis institutions Russian Federation
| Group/ subgroup accounting |
Characteristic contingents |
Periodicity doctor visits sick or sick doctor |
Observation period in the accounting group |
Treatment and diagnosis tic and preventive Events |
Criteria efficiency dispensary observations |
| 1 | 2 | 3 | 4 | 5 | 6 |
| Zero group | |||||
| 0 | Children and teenagers, people in need: - in clarification character tuberculin sensitive ti; - in diagnostics and clarification activity tuberculosis. |
Determined methodology diagnostics |
No more than 3 months. |
Complex diagnostic methods (in conditions hospital or dispensary) |
Diagnostics activity tuberculosis changes in respiratory organs Establishment diagnosis or etiology allergies to tuberculin. |
| Group 1 (active tuberculosis) | |||||
| I-A | Patients with widespread nym and complicated tuberculosis. |
At outpatient treatment - not less than 1 time per 10 days after stationary or sanatorium no treatment less than 1 time per |
No more than 24 months from moment of taking for registration. |
Complex main course treatment, with availability indications - surgical treatment, sanatorium treatment. Visit to the general schools allowed only after graduation main course treatment. |
Transfer to II group no more 10% of all patients with active tuberculosis. Transfer to III-B subgroup of people with tuberculosis intoxication, limited forms tuberculosis in 95% of cases in deadlines up to 9 months. Absence mortality from tuberculosis |
| I-B | Patients with small and uncomplicated forms tuberculosis. |
No more than 9 months from moment of taking for registration. |
|||
| Group 2 (active tuberculosis with chronic course) | |||||
| II | Patients with chronic with the current tuberculosis, in need of continuation treatment. |
Determined condition patient and carried out treatment. |
Duration observations are not limited. |
Individualized bathroom comprehensive chemotherapy with taking into account medicinal sensitivity MBT, surgical and sanatorium treatment, additional health Events. Visit to the general schools are not allowed. |
Translation 80% patients in III-B subgroup through 12 months. |
| Third group (risk of relapse of tuberculosis) | |||||
| III-A | First identified persons with residual post-tuberculosis- nym changes. |
At least 1 time at 3 months; V period anti-relapse courses - in depending on their methods carrying out. |
No more than 12 months. |
Complex examination is not less than 1 time in 6 months. Carrying out anti-relapse nal courses chemotherapy - according to indications. Events for social-labor- howl rehabilitation. Visit to the general schools allowed. |
Absence reactivation tuberculosis. Translation under observation clinics general medical slaughter locally residence 90% contingent III groups in 24 month. |
| III-B | Faces, translated from I, II, III-A groups. |
No more than 24 months. Persons with expressed residual changes, transferred from Groups I and II, watch until transfer to dispensary compartment for adults. |
|||
| Fourth group (contacts) | |||||
| IV-A | - Children and teenagers of all ages, consisting of household (family, related, apartment) contact with sick active form tuberculosis with bacteria excretion tion, as well as with bacteria excreted tel and, identified in children's and teenage institutions - Children and teenagers, living on territories tuberculosis institutions. |
At least 1 time at 6 months. IN period prophylactic whom to treat - depending from his methodology carrying out. |
All period contact and not less than 1 year from moment termination activity tuberculosis process sick. For persons, contacted with the deceased from tuberculosis sick - 2 of the year. |
Complex examination 2 once a year. Mode and technique chemotherapy are determined individually with taking into account factors risk. General strengthening Events, promoting increase immunity, in incl. sanatorium treatment. |
Absence diseases tuberculosis in process observations and within 2 years after prophylactic to their events. |
| IV-B | Children from contact with sick active tuberculosis without bacteria excretion nia Children from families livestock breeders, working for disadvantaged on tuberculosis farms, as well as from families having sick tuberculosis agricultural veins animals. |
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| Fifth group (complications after anti-tuberculosis vaccinations) | |||||
| V-A | Patients with persistent And disseminated Noah BCG infection, including defeat bone-joint- no system, purulent-caseosis- ny lymphadenitis (with loss 2 and more groups). |
Determined condition patient and carried out treatment, but not less than 1 time per 10 days. |
Duration observations are not limited. |
Complex main course treatment. At availability indications - surgical treatment. Events for medical-social Noah rehabilitation. Visiting common children's institutions allowed. |
Conversion to V-B group 20% of everyone's first time identified sick. Achievement medical and social-work Dovoy rehabilitation. |
| V-B | Patients with limited and local lesions: purulent-caseosis- lymphadenitis one group lymphadenitis without fistula, cold abscess, ulcer, infiltrate larger than 1 cm, - growing keloid scar. |
Determined condition patient and carried out treatment, but not less than 1 time per month. |
At least 12 months. |
||
| V-B | Persons with inactive BCG infection: - first identified lymphadenitis in phase calcification, not growing keloid scar; -translated from V-A and V-B groups. |
At least 1 time at 6 months. IN period prophylactic whom to treat determined its methodology carrying out. |
Duration observations are not limited. |
||
| Sixth group ( increased risk tuberculosis disease) | |||||
| VI-A | Children and teenagers in early period primary tuberculosis infections (turn tuberculin reactions). |
At least 1 time at 6 months. IN treatment period determined its methodology |
No more than 1 year. In the presence of medical-social nal factors risk, as well as for persons with sick, dead from tuberculosis - 2 years. |
Complex examination 2 once a year. Mode and methodology chemotherapy determine individually with taking into account factors risk. |
Absence diseases tuberculosis. |
| VI-B | Children and teenagers, previously infected, With hyperergic reaction to tuberculin. Children and teenagers from social risk groups with expressed reactions to tuberculin. |
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| VI-B | Children and teenagers with increasing tuberculin sensitive tew. |
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Notes
If active tuberculosis, a turn of tuberculin reactions and hyperergy are detected in children and adolescents, it is necessary to examine all family members within 2 weeks.
Medical and social risk factors are: lack of BCG vaccination at birth, concomitant chronic pathology, the presence of resistant MBT strains at the source of infection, socially maladjusted, large, low-income families, migrants and refugees.
1. Children and adolescents from group I-A can be admitted to groups if the following mandatory criteria are met: pronounced positive dynamics; absence of Mycobacterium tuberculosis during bacterioscopic examinations and 3-fold negative cultures for Mycobacterium tuberculosis; closing decay cavities.
2. Persons who have demonstrated an increase in sensitivity to tuberculin during the first 3 months. observed in the zero group. They are transferred to the VI-B accounting group only with a further increase in sensitivity or the presence of medical and social risk factors.
3. Patients with active tuberculosis in the presence of anamnesis, clinical, radiological and other data indicating a connection with anti-tuberculosis vaccination are observed in registration groups V-A and V-B. They are transferred to group V-B after cure only if residual post-tuberculosis changes persist.
4. In accounting group I-A, patients with decay of lung tissue and bacterial excretion are distinguished.
5. Residual post-tuberculosis changes in the respiratory organs in children and adolescents are defined as:
Minor: single calcifications in the lymph nodes and lungs, fibrosis within one segment;
Moderately expressed: small calcifications in several groups lymph nodes, a group of dense and calcified lesions in the lungs, fibrosis within a lobe or 1-2 segments in both lungs;
Pronounced: massive calcification in several groups of intrathoracic lymph nodes, lesions in the lungs, pneumosclerosis in 2-3 lobes or in 1 lobe with the presence of bronchiectasis.
Table 4
Scheme of examination of children and adolescents registered at the dispensary
| where | Radiation methods research |
Tuberculinaceae samples |
Laboratory research |
| 1 | 2 | 3 | 4 |
| 0 | X-ray tomography physical examination when setting on accounting, in the future according to indications |
When taking and taking off taking into account the Mantoux sample with 2 TE PPD-L. For differential diagnostics post-vaccination and infectious allergies Necessarily carrying out titration with threshold determination sensitivity to tuberculin |
General clinical blood and urine tests registration, further on indications. For diagnostics |
| I-A | X-ray tomography physical examination respiratory organs before enrolling in group, then 1 time at 2 months, during chemotherapy in months before decision to transfer to the continuation phase and before completion course of chemotherapy, in the continuation phase - according to indications |
When registering Mantoux test with 2 TE PPD-L and titration with definition threshold sensitivity to tuberculin. Next 1 time in 6 full months complex tuberculin diagnostics tics |
General clinical urine blood tests monthly during treatment, then 1 time every 3 month. Sputum examination for registration three times before the start treatment, with bacterial excretion 1 time per month until abacillation When absence bacterial discharge 1 time at 2-3 months. |
| I-B | |||
| II | For extrapulmonary tuberculosis - X-ray tomography physical examination affected organs according to indications, overview radiograph chest organs cells at least 1 once every 6 months |
Try. Mantoux with 2 TE PPD-L 1 time every 6 months, |
|
| III-A | X-ray tomography physical examination when setting on accounting and withdrawal from accounting, during observations - according to indications. |
When registering: Mantoux test with 2 TE PPD-L and titration with definition threshold sensitivity to tuberculin. |
General clinical blood tests, urine tests 1 once every 6 months, with anti-relapse courses chemotherapy once every month. |
| III-B | X-ray tomography physical examination when setting on accounting and withdrawal from accounting; during observations - 2 times in year |
Next 1 time in 6 full months complex tuberculin diagnostics tics. |
chemotherapy courses 1 once a month. Sputum examination 1 once a year. |
| IV-A | X-ray tomography physical examination when setting on accounting and withdrawal from accounting; during observations - according to indications. |
When taking and taking off registered: sample Mantoux with 2 TE PPD-L and titration with threshold determination sensitivity to tuberculin. |
General clinical blood and urine tests preventive treatment monthly, thereafter according to indications. Sputum examination for MBT according to indications |
| IV-B | |||
| V-A | X-ray tomography physical examination when setting on accounting and withdrawal from accounting; during observations - according to indications |
Mantoux test with 2 TE PPD-L 1 time in 6 months. |
General clinical blood and urine tests monthly in progress treatment, subsequently indications. Study biopsy for MBT affected area with diagnosis of the disease |
| V-B | |||
| V-B | |||
| VI-A | X-ray tomography physical examination respiratory organs with registration. When deregistered overview radiograph chest organs cells; tomograms mediastinum - only in case growth sensitivity to tuberculin. |
When taking and taking off registered: sample Mantoux with 2 TE PPD-L and titration with threshold determination sensitivity to tuberculin. During the observation - Once every 6 months full complex tuberculin diagnostics tics |
General clinical blood and urine tests preventive treatment monthly, thereafter according to indications. Sputum examination for MBT according to indications |
| Vl-B | |||
| VI-B |
Notes
1. Patients with respiratory tuberculosis during hospitalization should be examined by specialists in extrapulmonary tuberculosis.
2. All persons observed in the dispensary registration groups with pathology in urine tests and/or a history of kidney disease, regardless of the dispensary registration group, undergo 3 urine tests for MBT.
3. In children over 10 years of age and adolescents, during dynamic observation after completion of the course of treatment in
It is a problem on a global scale, its solution is a national task. Patients are registered in special territorial institutions of district, city, and regional significance. To distribute patients into groups for dispensary registration for tuberculosis, clinical and epidemiological indicators are taken into account.
Clinical examination of patients
Clinical examination is a set of measures aimed at detecting and preventing outbreaks of tuberculosis and eliminating mass infection.
Areas of work of the institution:
The organizational cabinet plans methods of anti-tuberculosis measures and analyzes their effectiveness in practice.
The need for registration
The decision to register a person with a dispensary is made by a special medical commission. The patient is informed about the decision of the board of doctors in writing, approved by the Ministry of Health of the Russian Federation (Ministry of Health).
Monitoring of the patient's condition and the effectiveness of treatment is carried out both in inpatient and outpatient settings, regardless of the patient's consent. Such measures are intended to prevent an increase in infections among healthy populations.
The period of observation for pulmonary tuberculosis is strictly regulated by the regulations of the Ministry of Health. A person is registered at his place of residence. If the registration address changes, the patient is obliged to notify the relevant authorities within 10 days.
The main goal of conducting statistical surveillance at the state level is to prevent the spread of tuberculosis.
Accounting groups for adult patients
In adults, there are 5 groups into which patients are divided. Such identification is based on epidemiological and treatment principles.
Groups for adults:
- “0” – assumption of the presence of tuberculosis in the body, the activity of the disease has not been established, additional, more in-depth diagnostics are expected.
- “1” – active form of infection. “1A” – primary diagnosis, “1B” – recurrent tuberculosis, “1B” – the disease is not fully treated or the effectiveness of previously administered therapy is unknown.
- “2” – chronic tuberculosis in the active stage. “2A” – at timely treatment full recovery is possible, “2B” – cure of lung infection is impossible.
- “3” – cure of the disease regardless of the presence of residual complications.
- “4” – those in contact with tuberculosis patients. “4A” – at home, “4B” – at work (medics).
According to WHO recommendations, patients in groups 1-4 must undergo treatment, and not just observation. People who have been diagnosed with primary tuberculosis and have successfully completed a therapeutic course are excluded from the medical examination category. If after the end of chemotherapy the patient has recovered, he is transferred to the 3rd group. On average, one course of treatment lasts from 6 to 9 months, two courses – 1-2 years.
People who have been in contact with patients and are at risk are intensively monitored for 12 months. Persons in whom it is not possible to establish the activity of the pathological process are registered at the dispensary for 3 months. Patients with minor residual effects are followed up for 3 years.
If the consequences of pulmonary tuberculosis are more severe, the person is registered for 10 years. If tubercles larger than 4 cm are detected, the patient is observed for cirrhosis of the liver for life.
Assignment of observation groups for children
Children's and adolescent dispensary observation groups:
According to WHO statistics, children with intoxication are included in the section “tuberculosis of unknown localization.” The duration of treatment should not exceed 2 years. Children with residual effects, regardless of age, are observed by a phthisiatrician until adulthood (up to 18 years). If a child comes into contact with a mycobacterial excretor, he is observed during this entire time. After the contact is completed, clinical examination stops after a year.
The observation period for children with a hyperreaction to a tuberculin test is from 1 to 2 years. The same number is observed when the child does not have BCG vaccination. If there is simply increased sensitivity or individual intolerance to the drug for intradermal testing, then in this case observation does not exceed 6 months.
Clinical examination in combination with preventive measures reduces the number of cases of the disease and relapses. State support, the creation of special programs, and sufficient funding play an important role. To isolate a tuberculosis epidemic, not only qualified health care, but also the consciousness of citizens.
When registered at a tuberculosis dispensary, each patient is faced with the dominant system of tuberculosis patients. According to this system, every person, whether an adult or a child in adolescence, registered due to suspected tuberculosis, is assigned to one of five existing groups. Classification is carried out strictly according to established criteria.
Medical examination of patients in the majority is carried out solely at the request of the patients, not counting those cases when the patient has a special form of tuberculosis and is obliged to begin treatment by order of the court. Treatment in dispensaries is provided at state expense.
The dispensary can be divided into several main components:- Hospital
- Outpatient department.
- Physiotherapy service.
Dispensaries are created in order to detect tuberculosis in the early stages, before major damage is caused to the body, and to begin treatment on time. As soon as the disease is cured, the patient is removed from the register.
Under no circumstances should tuberculosis be allowed to spread. If treatment is not started on time, irreversible changes in the body may occur, the person will be at risk of disability, and will remain registered at the dispensary for the rest of his life.
Purposes of registration
Tracking the incidence rate and the ability to constantly monitor potential patients are the main reasons that made the creation of tuberculosis dispensaries a real need. Tuberculosis poses a great danger to the population as a disease that spreads primarily through airborne droplets (in rare cases through blood), which makes it a global public problem. The causative agent of tuberculosis is Koch's bacillus.
Registering tuberculosis patients and tracking their condition can significantly reduce the spread of the disease.
Thus, we can identify several main goals that are achieved through registering patients:- implementation of strict observation and control of treatment;
- carrying out preventive measures with greater effectiveness;
- free transfer of patients from one group to another;
- systematic registration of persons entering or deregistering.
Registration of tuberculosis patients allows you to create an organized system, the existence of which saves many important resources, including time previously spent searching for cards among unsorted documents.
Observation groups
It is customary to differentiate five observation groups into which patients are divided depending on how well they meet a number of criteria.
Each group has its own serial number:
- zero;
- first;
- second;
- third;
- fourth.
If there are changes, transfer from one group to another is possible.
Zero group
The zero group includes those whose presence of tuberculosis is controversial. Often these people positive reaction Mantoux (diaskintesta) that do not have other signs of tuberculosis. Doctors monitor them to determine whether the reaction is caused by an infection or another factor ( allergic reaction, concomitant disease, etc.). Also included here are those who have not been diagnosed with tuberculosis activity
For convenience, the two streams of people are divided into two subgroups - A and B. Subgroup A includes those who need to determine the level of tuberculosis activity, and group B includes those who have to diagnose the disease (for this, differential methods are mainly used).
The first group includes people who have a form of tuberculosis with greater activity in the foci of the disease. It does not matter what form of tuberculosis (lungs, larynx, kidneys, etc.) a person suffers from; division into subgroups is made according to other criteria. As in the zero group, in the first group two subgroups are differentiated - A and B. Subgroup A includes people who have never had tuberculosis before and are encountering this disease for the first time. Consequently, the participants in the second subgroup are people to whom, for some reason, the disease they had previously experienced returned.
It is possible to identify additional subgroups. Subgroups “B” are created for people whose examination or treatment for objective reasons and circumstances has not been completed. In the main subgroups in some tuberculosis dispensaries, people are divided into those who isolate bacteria and those who do not.
Second group
The second group includes people with high tuberculosis activity, regardless of the form of the disease, who have a chronic course. Here, as in previous cases, there is a division into two streams of people.
Subgroup A includes not hopeless patients for whom intensive treatment using drugs on time can give good results until the final cure of the disease.
The second subgroup includes more hopeless patients, the development of the disease in which has reached such heights that intensive therapy produces virtually no results. Their treatment is aimed at strengthening the entire body and immunity. Anti-tuberculosis therapy and other health measures are recommended for them.
The goal of the third group is to exercise control over those who have recovered from tuberculosis. The existence of a third subgroup helps monitor the recovery of patients after the disease.
The form of tuberculosis, the presence or absence of residual changes does not play a role here. The peculiarity of the third group is that, unlike the previous ones, there is no division into subgroups. All people, whether they have residual effects or not, are united into one large group.
Fourth group
The last fourth group includes people who do not have tuberculosis, but are in permanent direct contact with infected people and are at risk of becoming infected. Most often, these are those whose close relatives (one of their parents, brothers, sisters) are infected, and household contact cannot be avoided. However, this category also includes those who have to come into contact with sick people due to their work.
Here, the division of patients into two large subgroups is obvious - A and B. Subgroup A includes people who have daily household contact with infected people. Subgroup B includes people whose regular contacts are determined by the characteristics of their profession (the need to frequently communicate with strangers on work issues).
The purpose of the fourth group is to limit and prevent the spread of the disease, monitor the health status of those who are exposed to a certain danger on a daily basis, and carry out preventive measures for them.
Some dispensaries practice separating several more groups of patients for better control, although most prefer a system that includes five main groups.
Additionally, the fifth, sixth and seventh groups are distinguished. The fifth group includes people whose tuberculosis affects systems other than the respiratory system. With these forms of tuberculosis, severe damage can be caused not only to the lungs, but also to other organs.
The sixth group (children's) was created for children in whom the Mantoux test gave a positive result. However, it has not been proven that they have tuberculosis. Such children are considered to be at risk, so their condition must be monitored.
The seventh group includes those who have already been cured of tuberculosis, but have not gotten rid of residual effects. For them, there is a high probability of recurrence of the disease, which explains the selection of a separate group for control.
The distribution of people into groups is based on the diagnosis given to them. In turn, a diagnosis is possible only after a series of studies:
- X-ray chest.
- Sputum analysis.
Symptoms alone are not enough. It is necessary to conduct research and pass all tests. Then the doctor can make a conclusion and determine which group of dispensary records the patient should be assigned to. The frequency of testing is determined by the group to which the person is assigned.
For the first subgroup of group 1, tests are not carried out very often. Its participants repeat chest x-rays every two months as long as bacteria continue to be released into the environment. In the future, the frequency of this study will decrease - it will be conducted every three months (quarter) or after four months.
For the second subgroup, during the period of exacerbation of the disease, chest radiography should be performed every two months. Subsequently, the frequency of radiography is reduced to one image every six months. Sputum analysis is carried out at approximately the same frequency - every three months during an exacerbation and once every six months when the activity of the infection subsides.
Each subgroup of group 2 is faced with the need to repeat all tests and studies every three months. The following tests are required: chest x-ray, sputum examination.
Participants in group 3 undergo studies with less frequency. Chest X-rays and sputum examinations are performed every six months.
For participants in group 4 of tuberculosis registration, fluorography is performed every six months. None additional research not required for them.
Even if tests show that the patient has been cured of tuberculosis, he needs to undergo tests every year so that the disease does not recur without the knowledge of doctors.
To determine the activity of the tuberculosis process, several basic terms are used:
- Tuberculosis of doubtful activity.
- Active tuberculosis.
The difference between these concepts is quite obvious: in one case, tuberculosis takes an active form, which is a serious reason for enrolling the patient in the first group of dispensary registration. In the second case, the disease does not show activity and the patient is placed in the zero group.
People who are diagnosed with tuberculosis of questionable activity are placed in the zero group until the circumstances are clarified. Over the course of several weeks, for a patient placed in the zero group, diagnostic measures, which help determine the level of disease activity. If an active form of tuberculosis is detected, the patient is transferred to the first group; if no activity is detected, the patient is deregistered and sent for treatment to another medical institution.
In the active form of tuberculosis, inflammation occurs. The active form of tuberculosis is much more dangerous. It is determined by studying a chest x-ray and conducting various types of research. The patient is assigned to the first group, where he can receive the necessary drug therapy.
Why are residual changes of tuberculosis dangerous?
It was customary to designate several criteria by which it is established that a person has been completely cured of tuberculosis:
- Immunity stability.
- Lack of activity and changes in the organs of the respiratory system.
- Tuberculosis microbacteria are not detected in the discharge.
- The reaction to the tuberculin test is negative.
Patients with residual changes can be assigned to the seventh or third group of dispensary registration for tuberculosis.
It is important not to lose sight of residual changes that may persist after treatment has ended. If residual effects are not eliminated, the disease may recur.
Residual effects are found in the respiratory organs and throughout the body as a whole (due to surgical interventions). Their presence indicates that the person has not been completely cured of tuberculosis.
Some of the common residual changes are fibrotic changes lungs. Treatment of this disease is necessary, because it can lead not only to a relapse of tuberculosis, but also to death.
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Congratulations! The likelihood that you will develop tuberculosis is close to zero.
But don’t forget to also take care of your body and undergo regular medical examinations and you won’t be afraid of any disease!
We also recommend that you read the article on.There is reason to think.
It is impossible to say with certainty that you have tuberculosis, but there is such a possibility; if this is not the case, then there is clearly something wrong with your health. We recommend that you immediately go through medical examination. We also recommend that you read the article on.
Contact a specialist urgently!
The likelihood that you are affected is very high, but it is not possible to make a diagnosis remotely. You should immediately contact a qualified specialist and undergo a medical examination! We also strongly recommend that you read the article on.
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Task 1 of 17
1 .
Is your lifestyle associated with severe physical activity?
Task 2 of 17
2 .
How often do you take a tuberculosis test (eg Mantoux)?
Task 3 of 17
3 .
Do you carefully observe personal hygiene (shower, hands before eating and after walking, etc.)?
Task 4 of 17
4 .
Do you take care of your immunity?
Task 5 of 17
5 .
Have any of your relatives or family members had tuberculosis?
Task 6 of 17
6 .
Do you live or work in an unfavorable environment(gas, smoke, chemical emissions from enterprises)?
Task 7 of 17
7 .
How often are you in damp, dusty or moldy environments?
Task 8 of 17
8 .
How old are you?
Task 9 of 17
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What gender are you?
Collapse
is an insidious disease that anyone can become infected with. Every person is required to undergo a preventive examination annually, which will show whether or not there is a mycobacterium infection. In case of questionable results or obvious infection, the person is sent to a tuberculosis dispensary. This is an institution where examination continues and treatment is carried out if necessary. According to regulatory documents, there are several groups of dispensary registration for tuberculosis. Let's look at them in detail.
Definition
Dispensary groups are special cells that are divided according to the form and severity of tuberculosis. Before treatment begins for a patient, the TB specialist must assign him to the appropriate group. This makes it possible to approach each individual individually, simplifying the path to recovery and symptom relief.
In total, there are 4 groups for recording tuberculosis patients (they are also divided into subgroups).
Groups of tuberculosis patients are based on the therapeutic and epidemiological principle. Approved by the Ministry of Health of the Russian Federation.
It should be noted that the groupings under consideration are systematically revised.
Order 109 on tuberculosis, which was issued in 2003, was amended in 2017 and states the advisability of all measures against tuberculosis.
Purposes of registration
When registering a patient at a dispensary, the following goals are pursued:
- Creation separate groups similar forms or severity of the pathology, which makes it possible to properly observe patients and promptly call them for examination.
- Saving time allocated for visits, consultations and treatment periods.
- Clear observation of dynamics by transferring the patient from group to group.
- Coordinated work in maintaining documentation.
- Correct and quick determination of treatment tactics.
- Timely implementation of various activities and deregistration of patients (who have undergone treatment and overcome the disease).
Surveillance groups and what do they mean?
As mentioned above, there are 7 groups in total. Each has its own special characteristics.
0 group
This group includes people:
- having an unspecified active process;
- requiring a high-quality examination, after which a residual diagnosis will be made and the form and localization of the infection will be clarified.
There are also divisions into subgroups.
0-A
These are patients who have an unspecified diagnosis of the presence of MBC in the body.
0-B
Those who are waiting for differentiated diagnostics, which will show which group they will be assigned to.
If tuberculosis is in doubt, or rather its active form, then this group is for such cases. Means:
- various unclear changes on x-rays;
- positive tests of Mantoux, Diaskintest, Quantiferon test, etc.;
- deviations in analyzes and so on.
1 group
There are tuberculosis cases here, in which the form is in the active phase. Localization doesn't matter. Here there is a division into 2 subgroups.
1A
This refers to people who were infected with Koch's bacillus for the first time.
1B
Patients who have recurrent pathology.
In both subgroups there is a division into patients who:
- Mycobacteria are isolated. As a rule, this includes the presence of MBC not only in sputum, but also in urine, feces, etc. If Koch's bacillus is found in the puncture fluid, then this does not count.
- MBC is not isolated. There are no active microorganisms that enter the external environment. Patients are also transferred here when they stop excreting bacteria after a therapeutic course. This condition is called abacillation - the disappearance of mycobacteria.
- Those patients whose treatment was interrupted or were not examined after the therapeutic course. Such individuals may still have active tuberculosis.
2nd group
The 2nd group is characterized by the fact that it contains people with chronic pathology, while the form is active. Localization is not important.
It is also divided into additional groups.
2A
Here are tuberculosis patients whose disease may be cured, but this requires strong medication or other therapy.
2B
Individuals classified in this subcategory triggered the disease. It cannot be cured with any anti-tuberculosis drugs.
3 group
There are people here with any location of tuberculosis who have cured it. This is the so-called control group.
4 group
Individuals who end up here are in systematic contact with the carrier of the infection. These are people from the risk zone.
4A
People who come into contact with a person with tuberculosis at home or at work.
4B
Here are all the workers of tuberculosis dispensaries and other medical institutions who are forced to communicate and come into contact with infected people, as this is inevitable in their professional activities.
Indicators and criteria for tactics of dispensary observation and recording
There are some features and indicators that guide TB specialists.
- Questionable activity. If there are unknown changes in the lung tissue or other organs, this is a zero group. In it, people undergo a complete diagnosis, using several methods at once. Most often during the passage comprehensive examination patients are under medical supervision of qualified specialists. This lasts no more than three weeks. If the diagnosis is not confirmed and the person mistakenly ends up in a tuberculosis clinic, he is sent home. In another case, he is sent to the next group (first) or sent to a special therapeutic and preventive sanatorium.
- Active phase of tuberculosis. There is a specific inflammation here that is caused by MBC. Such patients fall into group 1. This form is identified after a comprehensive diagnosis. It includes x-ray, fluoroscopy, tomography, bronchoscopy, fluorography, PCR, sputum microscopy, serological method, tests, etc. After this, treatment for tuberculosis of the lungs or other organs is necessarily prescribed. Next is diagnostics again. If everything is normal, then they resort to staying in specialized sanatoriums, where the patient’s rehabilitation takes place.
- Chronic form of the disease. This is the one that is present in a person for more than 24 months. Even if there are periods of remission, and then exacerbation again. The remaining active form belongs to the second group. Pathology usually reaches this level in those patients who:
- they did not start treating her on time;
- not identified in a timely manner;
- have a weakened immune system;
- were on treatment that did not give the expected result;
- had concomitant diseases that interfered with the cure of tuberculosis.
This group also includes those people who did not experience positive dynamics during their stay in the first group for two years.
- Bacteria eliminators. People who shed Koch's bacillus can infect others as a result. This includes discharge in the form of menstruation, sputum, saliva, urine, feces, etc. Bacterial discharge is detected immediately upon entering the TB dispensary.
- Abacillation. This is when the tuberculosis bacillus stops being released. This usually happens after long-term and competent treatment. This can be determined by cultural and bacterioscopic examination.
- Post-tuberculosis residual changes. This implies the presence of foci and foci, cirrhotic and fibrous foci, postoperative changes, pleural formations, and improper functioning of the organ after a therapeutic course. There are small changes - if the formations are no more than three cm (single in nature) or 1-2 cm, fibrous no more than two segments. Large – all those that exceed the listed standards.
- Tuberculosis of a destructive nature. In pathology, tissue breakdown is present. To identify this, you need to undergo an X-ray examination.
- Progressive or aggravated disease. Here new signs of the disease are found. They may appear during treatment and after visible improvement. This indicates that treatment is not suitable.
Formulation of diagnosis
Here are examples of including a person in category 1:
- There is a lesion of the lung on the left upper lobe, of an infiltrative nature. It is in the decay phase, there is contamination. Mycobacteria are isolated.
- There is cavernous tuberculosis of the left kidney with the release of mycobacteria.
An example of transferring a patient to group 2:
- The person had infiltrative tuberculosis. The course of the pathology was unfavorable, which resulted in a cavernous form.
Transfer to group 3:
- Pathology is present in the right lung of the lower lobe. There are large residual changes that have spread to neighboring lobes.
- The lung of the upper lobe is affected on the right. There are minor residual changes. These are single lesions no more than 3 cm.
Conclusion
All groups of dispensary registration for tuberculosis have their own characteristics. Before including or transferring a person to one category or another, the doctor conducts a thorough examination and examines the patient. Such divisions make the doctor’s work easier, make it possible to observe the dynamics of the disease, and save time. Treatment of tuberculosis in children and adults becomes more effective, since it is possible to promptly identify negative dynamics and change treatment if necessary.
