Conform estimrilor Organizaiei Mondiale a Sntii, anual, n lume, se nregistreaz circa 9milioane de cazuri noi de tuberculoz i peste 1,5 milioane de persoane care decedeaz din cauza acesteiboli. Tuberculoza este una dintre cele mai raspndite i persistente maladii infecioase.Aproximativ otreime din populaia globului este infectat cu mycobacteria productoare de tuberculoz. La rndul sau,fiecare persoan cu tuberculoz activ poate infecta, n mediu, 10-15 persoane pe an.

n R.Moldova, n anul 2011, la 100000 de locuitori 113 persoane sunt bolnave de tuberculoz . Astfel,Moldova este printre 18 ri cele mai contaminate din regiunea european. Numrul persoanelor bolnavede tuberculoz este n cretere. n timp ce medicii bat alarma, exist persoane care refuz categoric s setrateze, supunnd unui risc enorm att pe ei nii, ct i pe oamenii care-i nconjoar. Mai mult, exist ipersoane care sunt externate forat pe motiv c nu respect regimul spitalicesc.

Tuberculoza este o infectie produsa de o bacterie numita Mycobacterium tuberculosis (bacilul Koch).Aceasta inefectie afecteaza in general plamanii dar se poate manifesta si la nivelul altor organe, mai ales lanivelul sistemului osos si creier.

Trebuie sa va precizez ca termenii de infectie si cel de boala sunt diferiti. Infectia cu aceasta bacterieinseamna ca ea a patruns in organism dar nu neaparat a determinat boala. Aceasta infectie poate fi in starelatenta, cand pacientul nu are nici un fel de simptome, dar este purtator (el inca nu transmite mai departeinfectia decat daca tuberculoza devine activa). Acestui pacient oricand i se poate declansa boala tuberculoza activa, atunci cand prezinta simptomatologie si de asemenea potential infectant pentrupersoanele din jur.

In general tuberculoza afecteaza oamenii cu un sistem imunitar scazut, pe cei ce traiesc in medii umede, pecei defavorizati, care nu se pot hrani suficient de bine, pe cei care lucreaza numai in aer liber (santiere),copii sub 3 ani si batranii precum si persoanele cu diverse boli ce scad mult imunitatea (spre exempluHIV/SIDA).

Cum ne infectam?Este de ajuns sa ne aflam in preajma unei persoane infectate. Aceasta tuseste sau stranuta (canta sau rade,asa expira mai mult aer infectat) si imprastie in aer bacteriile respective, pe care noi mai apoi le inspiram.

Uneori boala poate fi transmisa si de vitele infectate prin consumarea laptelui nefiert sau nepasteurizat.Perioada de incubatie este intre 4 si 12 saptamani.

Care sunt simptomele tuberculozei?Simptomatologia difera de la forma latenta in care este absenta la forma activa a tuberculozei undesemnele si simptomele isi fac aparitia. Simptomatologia depinde foarte mult de organul afectat detuberculoza, cel mai adesea plamanul, dar sunt si cazuri de tuberculoza la nivelul altor organe(extrapulmonar), cand simptomatologia insoteste insuficienta functionala a acelui organ. Uneorituberculoza poate fi confundata cu alte patologii pulmonare sau de organ si trebuie facut diagnosticuldiferential.

Simptomele tuberculozei active cu localizare pulmonaraAceste simptome apar treptat pe o perioada de saptamani sau luni, putand exista si simptome usoareaproape insesizabile de bolnav.

Cele mai frecvente simptome sunt: Tahicardie (ritmul rapid al batailor inimii) marirea in volum a gatului datorita afectarii ganglionilor limfatici de la acest nivel tuse cu mucus gros, in care uneori se poate vedea si sange, aceasta tuse durand cu

aproximatie doua saptamani transpiratii abundente nocturne febra si frisoane mai ales in timpul somnului stare de oboseala si epuizarea fortei fizice inapetenta si pierdere in greutate fara motive evidente dureri in piept etc.

La copii mici TBC-ul se poate manifesta doar prin oprirea cresterii.

In lipsa tratamentului, tuberculoza activa poate produce leziuni serioase, putand forma un fel de pungi depuroi cu continut cazeos (branzos, specific tuberculozei) care se pot suprainfecta cu alte tipuri de bacterii,fiind mult mai greu de tratat (de multe ori aceste pungi de puroi se evidentiaza abia dupa suprainfectare,

caci astfel devin simptomatice, pungile de puroi tuberculos nu au acele caractere infectioase ca tumefiere,inrosire, durere, cresterea emperaturii locale etc, tocmai din acest motiv se mai numesc si abcese reci). Sepot forma, tot ca si complicatii, fistule (comunicari) intre cai aeriene apropiate sau intre plaman si pleura(bronho-pleurale) etc. Aceste abcese pot astupa caile aeriene si produc insuficienta respiratorie si listacomplicatiilor poate continua. Din pacate, de cele mai multe ori, dupa tratarea complicatiilor raman sechelece vor persista toata viata.

Cum punem diagnosticul?In cazul prezentei simptomatologiei trebuie sa va prezentati cat mai rapid la medic.

Mai intai medicul discuta cu pacientul istoricul bolii (anamneza), discutand despre simptome, momentulaparitiei, intensitate, pusee, mediu de lucru, mod de deplasare etc. In general pentru a diagnostica prezentabacilului Koch se fac prelevari de sputa (mucusul eliminat prin tuse) si se trimite la laborator unde se vorface culturi din sputa. Daca este prezent bacilul, acesta va creste pe mediul de cultura. Din pacate aceastabacterie creste greu si rezultatele apar cu intarziere, dupa o saptamana sau chiar mai mult.

Daca bacilul a crescut pe mediilde de cultura in colonii, peste acestea se vor pune discuri de antibioticepentru a vedea ce antibiotic distruge primul colonia, apoi al doilea antibiotic care distruge coloniabacteriana etc. Aceasta este antibiograma si stabileste care sunt medicamentele la care germenul este celmai sensibil, pentru a se putea instaura un tratament exact cu acele substante. Se mai poate face testul latuberculina (testarea cutanata prin injectarea la nivelul pielii a tuberculinei, aceasta putand determina saunu o reactie locala). Pentru a se determina unele leziuni pulmonare se poate face si radiografie pulmonara.

Exista si alte teste pentru a pune in evidenta infectia TBC si care se pot folosi si in cazul tuberculozeilatente, cum ar fi QuantiFERON-TB Gold. Acesta este un test de sange mult mai accesibil, mai rapid simai sigur decat testul cutanat la tuberculina.

Daca se suspecteaza prezenta tuberculozei extrapulmonare, testul la tuberculina pozitiv sau alte teste dedepistare a tuberculozei pozitive, se vor face testari si pentru organul respctiv. Testele sunt foarte variate infunctie de organul afectat, tipul afectarii, gradul leziunilor, posibilitatea de acces etc. Astfel ca nu voi intrain detalii, exemplele find foarte numeroase.

Cum tratam tuberculoza?Tuberculoza este deci o boala grava, iar tratamentul sau este de lunga durata si necesita multa rabdare atatdin partea medicului cat si a pacientului, necesita administrarea mai multor medicamente antituberculoasesi schema de tratament trebuie respecatata cu strictete timp de cel putin sase luni.

Vreau sa insist asupra unui aspect al tratamentului care de cele mai multe ori nu este luat in seama de catrepacienti, agravand extrem de mult situatia nu numai a lor ca pacienti, ci si a celor caroroa ar putea sa letransmita mai departe infectia. Iata despre ce este vorba: aceste bacterii (ca toate bacteriile de altfel) trebuiesa primeasca in mod constant doze de medicament care sa le infraneze activitatea si sa le distruga. Daca seintampla ca unele din doze sa fie intarziate, aceste bacterii pot capata REZISTENTA!

Oricum sunt restranse tratamentele pentru tuberculoza, daca se intampla ca pacinetii sa nu respecte schemade medicamentatie si bacteriile devin rezistente si la acele tratamente, situatia poate deveni atat de gravaincat sa nu mai existe tratament pentru acele bacterii rezistente (si s-au raportat destule cazuri de acest gen).Pacientul poate da infectia mai departe si astfel sa apara o epidemie puternica si... ucigasa. Au fost astfel decazuri care cu greu au reusit sa fie izolate si in zilele noastre continua sa apara. Tocmai din acest motivschema de tratament cu antibiotice nu numai pentru tuberculoza ci pentru orice boala trebuie urmata cusfintenie. Spre exemplu infectiile genitale la femei care s-au cronicizat, deci nu mai raspund la tratamente,sunt din ce in ce mai numeroase, iar cauza este aceeasi: nerespectarea schemei de tratament.

Cea mai buna metoda de protectie a copiilor contra tuberculozei este imunizarea cu vaccinul BCG.

Exemple de medicamente antituberculinice pot fi: Izoniazida, Rifampicina, Pirazinamida, Etambutol,Streptomicina (STM), Rifampicina, Cicloserina (Seromicina), Capreomicina (Capastat Sulfat). Schema detratament pentru tuberculoza este cimplicata si depinde de gradul de infectivitate, de forma activa saupasiva, de afectarea si a altor organe etc, fiind particularizata fiecarui pacinent in parte. Durata medie atratamentului este intre 6 si 9 luni.

Teste efectuate in timpul tratamentului tuberculozeiSe testeaza sputa destul de des, aproximativ o data pe luna pentru ca medicul sa se asigure de eficacitatea

tratamentului. La sfarsitul tratamentului se poate face o radiografie pentru a o compara eventual cu unaviitoare, astfel pot fi identificate evolutii. Se mai pot face teste care sa investigheze daca tuberculoza nu aafectat alte organe: teste hepatice, oftalmologice (in special daca se administreaza ethambutol), testeacustice (in special daca se administreaza streptomicina).

Cum evitam infectarea cu bacilul Koch?Va trebui sa va feriti sa stati mult in aglomeratii unde pot fi persoane infectate cu TBC, sa purtati masti deprotectie daca lucrati in cadrul spitalelor sau faceti vizite in sectii spitalicesti unde sunt internati bolnavi cuTBC, de asemenea sa va vaccinati antiTBC BCG (la varstele la care se face acest vaccin).

Alimentatia si igiena sunt de asemenea conditii de baza pentru un organism sanatos cu un sistem imunputernic. De asemenea preparati termic mancarea, mai ales laptele de vaca ce trebuie fiert in cazul in carenu il cumparati de pe piata gata pasteurizat.

Gradul de rspindire a tuberculozei este destul de larg, intrucit 11% dintre subieci au menionat c eisau cineva dintre rudele lor au fost sau sunt bolnave de tuberculoz, iar fiecare aproximativ al 7-learespondent (sau 15%) comunic deseori cu cineva care a fost sau este bolnav (vecin, coleg de clas,prieten). De menionat c 6% dintre participanii la studiu nu tiu dac cineva dintre rudele sau cunoscuiilor a fost / este bolnav de tuberculoz. Dei societatea este obinuit cu prezena tuberculozei, intrebaidac tuberculoza este o maladie asociat stigmatizrii, fiecare al patrulea respondent consider c este oruine s fii bolnav de tuberculoz (23%), cu o pondere mai mare in mediu rural (26,8%) fa de municipii(16,9%) sau centre raionale (18,9%) i in populaie virstnic (29,5% in categoria de virst 50-65 ani) fade 17,4% printre cei 25-34 ani, cu un nivel de studii mic (30,8%) fa de nivel inalt (14,8%) i nivelsocio-economic mic (28,1%) fa de 17,4% printre cei cu nivel socioeconomic inalt. Fiind rugai sargumenteze de ce este o ruine s fii bolnav de tuberculoz, cei mai muli consider c aceast afeciunear putea cauza pierderea locului de munc (89%) i c oamenii ar evita persoana bolnav (88%), iar maimult de jumtate dintre respondeni consider c tuberculoza este o boal a oamenilor sraci, fr adposti beivi (58%).

De cele mai multe ori populaia rii evit s intre in contact direct cu persoanele bolnave detuberculoz, chiar dac acestea le sunt prieteni, colegi sau vecini. Astfel, doar o treime dintre respondeniicare au avut pe cineva dintre apropiai sau cunotine bolnave (n=213) au vizitat sau viziteaz persoanelebolnave de tuberculoz (33,4%), brbaii fiind in proporii mai mari decit femeile in acest sens (37,5% vs

27,2%), iar dou treimi din respondeni (sau 66,6%) nu fac vizite la domiciliul persoanelor care sufer deaceast afeciune, cu o prevalen mai mare in zona de Nord (74,1%) fa de 65,6% in zona Centru i61,7% zona de Sud. Cauza principal de evitare a fost menionat frica de contaminare (51,4%). Mai multde jumtate din respondeni (55,8%) sunt de prere c persoana bolnav de tuberculoz s-ar strdui sascund c este bolnav de cei ce o inconjoar, fr mari diferene in dependen de virst, sex, mediu dereedin, educaie sau statutul socio-economic. Cit privete motivele ascunderii, frica de a pierde prieteniireprezint 94% in rspunsuri; frica de a fi evitat de persoanele care te inconjoar (92%); teama c nimeninu va dori s se cstoreasc cu persoana bolnav constituie 88% i frica de a pierde locul de munc 84%.Pe de alt parte, majoritatea respondenilor (75,8%) ar accepta s ia acas o rud care s-a imbolnvit detuberculoz, s-a tratat in spital i trebuie s continue tratamentul la nivel de ambulator la domiciliu. Dintreacetia, aproape jumtate dintre respondeni (47,2%) ar primi aceast rud acas la ei pin la tratamentuldefinitiv dac persoana este o rud apropiat. Aproape fiecare al cincilea (18,5%) ar refuza s ingrijeascde rud, iar 6% ar sta la indoial dac s primeasc sau nu acas o persoan bolnav de tuberculoz pin latratarea sa definitiv. i de data aceasta, cei care ar refuza s ingrijeasc de o persoan apropiat in faza deambulator sunt in proporie mai mare persoane de la sate (21,6% fa de 7,5% din municipii), femei(21,9% fa de 14,6% brbai) i nivel de educaie mai jos (24,3% mic faq de 13,9% inalt) i statutsocio-economic jos (20,6% mic fa de 11,3% inalt).

According to estimates by the World Health Organization , each year in the world, there are around 9million new cases of TB and 1.5 million people die from the disease . Tuberculosis is one of the mostwidespread and persistent ailments infecioase.Aproximativ third of the world population is infected withMycobacterium tuberculosis producing . In turn , each person with active TB can infect on average 10 to15 people per year.

In Moldova , in 2011 , to 100,000 inhabitants 113 people are infected with tuberculosis. Thus ,Moldova is among the 18 most contaminated countries in the European region . The number oftuberculosis is increasing. While doctors knock alarm, there are people who flatly refuse to deal , puttingan enormous risk both themselves and the people around them . Moreover, there are persons who areforcibly discharged on the ground that does not comply with hospital rules .

Tuberculosis is an infection caused by a bacterium called Mycobacterium tuberculosis ( Kochbacillus ) . It usually affects the lungs ineffective but can also manifest in other organs , especially the boneand brain.

I have to say that the terms " infection " and the "disease" are different. Infection with this bacteriummeans that it has entered the body but not necessarily caused disease . This infection can be dormant whenthe patient has no symptoms, but bears ( he still does not forward unless the infection becomes activetuberculosis ) . This patient whenever i can trigger the disease - active tuberculosis when symptoms andalso shows potential for infecting bystanders .

In general tuberculosis affects people with a weakened immune system , those who live in damp ,those underprivileged who can not feed well enough , only those who work outdoors ( sites ) , childrenunder 3 years old and people with various diseases that fall more immunity (eg HIV / AIDS).

How do we get infected?It is enough to find us around an infected person. It coughs or sneezes ( sing or laugh , so more air

infected expires ) and respective bacteria spread in the air , which we then inspire them . Sometimes the

disease can be transmitted from cattle infected by eating raw or unpasteurized milk . The incubation periodis between 4 and 12 weeks.

What are the symptoms of tuberculosis ?Symptoms differ from latent form that is absent in the active form of TB where signs and symptoms

are appearing . Symptoms depend greatly affected organ tuberculosis , most often the lungs , but there arecases of tuberculosis in other organs ( extrapulmonary ) , when symptoms accompanying functionalimpairment of that organ. Sometimes tuberculosis can be confused with other lung diseases or organ anddifferential diagnosis must be made .

Symptoms of active TB with pulmonary localizationThese symptoms occur gradually over a period of weeks or months , there are mild symptoms can

almost imperceptible sick .

The most common symptoms are :Tachycardia ( rapid heartbeat )enlarged neck lymph nodes due to damage at this levelcough with thick mucus , which sometimes can be seen blood , this cough lasts about two weeksheavy night sweatsfever and chills , especially during sleeptiredness and exhaustion of physical forceloss of appetite and weight loss without obvious reasonschest pain , etc. .

Toddlers TB can occur just by stopping growth.

Without treatment , active TB can cause serious damage and can form a kind of pockets of puscontaining caseous ( cheesy , specifically tuberculosis) which may superinfection with other bacteria ,being more difficult to treat (often these bags pus is distinguished only after superinfection , because thusbecome symptomatic , pus pockets infectious tuberculosis have those characters as swelling , redness , pain,increasing local emperaturii etc, for this reason are also called cold abscesses ) . It can form all the

complications , fistula ( communication ) between close airways or lung and pleura between ( broncho -pleural ) etc. . These abscesses may obstruct the airway and cause respiratory failure and complications thelist goes on. Unfortunately , most times after treatment complications remain sequelae that persistthroughout life .

How do we diagnose ?If this symptom should see your doctor as soon as possible .

First the doctor talk to the patient medical history ( anamnesis) , talking about symptoms, time ofonset , intensity, flares , work environment , etc. mode of travel . In general to diagnose this bacillus Kochare sputum sampling ( mucus removed by coughing ) and send it to the lab where it will be sputum culture .If the bacillus is present , it will grow on culture medium . Unfortunately this bacterium grows slowly andlate results appear after a week or more.

If bacillus grew in colonies on culture mediilde over they will put antibiotic discs to see whatantibiotic destroys the first colony , and the second antibiotic that kills bacterial colony etc . This isantibiogram and determining which are drugs in which the germ is most sensitive to be able to establish anexact treatment of those substances . It can make tuberculin test ( skin test by injecting the tuberculin skinit can cause a local reaction or not ) . To determine some lung damage can be done CXR .

There are other tests to highlight TB infection and that can be used in the case of latent TB ,QuantiFERON -TB like Gold. This is a blood test more affordable , faster and safer than the tuberculinskin test .

If extrapulmonary TB is suspected , a positive tuberculin skin test or other tests positive fortuberculosis will be made for testing and respctiv body . Tests vary widely depending on the organaffected , the type of damage , the extent of injuries , etc. can access . So I will not go into details ,examples being very numerous.

How to treat tuberculosis?

Tuberculosis is therefore a serious illness , and treatment or is lengthy and requires patience from boththe doctor and the patient , requires the use of many drugs and antituberculosis regimen should be strictlyrespecatata for at least six months.

I insist on one aspect of treatment which often is not taken into account by patients, aggravating thesituation tremendously not only as their patients, but also those caroroa could they pass on the infection.Here's what it is : these bacteria ( bacteria that all otherwise) must receive constant dose of drug to restraintheir activity and destroy them . If it happens that some of the doses to be delayed, these bacteria canacquire resistance!

Anyway restrained treatments for tuberculosis , if it does not meet the pacinetii medication regimenand bacteria become resistant and those treatments , the situation can become so severe that there was notreatment for these resistant bacteria ( and have reported enough such cases ) . The patient may give furtherinfection and thus to experience strong ... killer epidemic . There were such cases hardly have failed to beisolated and continue to occur today . For this reason antibiotic treatment regimen for tuberculosis but notonly for any disease should be followed religiously . For example genital infections in women who have achronic , so do not respond to treatment are becoming more numerous and the cause is the same : failureregimen .

The best way to protect children against tuberculosis with BCG immunization .

Examples of drugs antituberculinice include: isoniazid, rifampin, pyrazinamide , ethambutolstreptomycin (STM ) , Rifampicin , Cycloserine ( Seromicina ) , capreomycin ( Capastat sulfate ) .Treatment regimen for tuberculosis is cimplicata and depends on the degree of infectivity , active orpassive form of impairment and other organs etc. are customized to each pacinent in part . The averagelength of treatment is between 6 and 9 months.

Tests during treatment of tuberculosisThe sputum test often , about once a month to the doctor to ensure efficacy . At the end of treatment

may be an x-ray to compare it with one possible future developments can thus be identified . It can make

tests to investigate whether tuberculosis did not affect other organs : liver tests , eye (especially if givenethambutol ) , acoustic tests (especially if given streptomycin ) .

How to avoid Koch bacillus infection ?You should stay away to stay long in crowds where person can be infected with TB, to wear protective

masks if you work in hospitals or make visits to hospital wards where patients are hospitalized with TBalso be vaccinated antiTBC - BCG ( the ages at which the vaccine is made ) .

Nutrition and hygiene are also basic conditions for a healthy body with a strong immune system . Alsocooked food , especially cow's milk to be boiled if you buy from the market is not ready pasteurized .

The degree of spread of tuberculosis is quite broad , since 11% of respondents said that they or any oftheir relatives have been or are suffering from tuberculosis , each approximately the 7th respondent (or 15% ) often communicate with someone who has been or is sick ( neighbor, classmate , friend ) . Note that 6% of respondents did not know if any of their relatives or acquaintances was / is suffering fromtuberculosis . Although the company is used to presence of tuberculosis , wondering if tuberculosis is adisease associated stigma , one in four respondents consider it a shame to be suffering from tuberculosis(23% ) , with a higher proportion in rural areas (26.8 % ) to municipalities (16.9 %) and regional centers(18.9 %) and the elderly population (29.5 % in the age category 50-65 years) compared to 17.4% amongthose 25-34 years with a lower educational level (30.8 %) than high ( 14.8 %) and lower socioeconomiclevel (28.1 %) compared to 17.4% among those with high socioeconomic level . When asked to argue whyit is a shame to be suffering from tuberculosis , the majority believes that this condition could cause jobloss ( 89 % ) and that people should avoid sick person ( 88 % ) and more than half of respondents believethat tuberculosis is a disease of the poor , homeless and drunks ( 58%).

The population often reluctant to enter into direct contact with people suffering from tuberculosis,even if they are friends, colleagues or neighbors . Thus, only a third of respondents who had someone closeor knowledge of patients ( n = 213 ) visited or visiting the sick with tuberculosis (33.4 % ) and males inhigher proportions than women in this regard ( 37 5 % vs 27.2 % ) and two thirds of respondents (or 66.6% ) do not make at home for people suffering from this disease , with a higher prevalence in the North(74.1 %) compared 65.6 % and 61.7% in the Center South region . The main reason was mentioned fearavoidance of contamination (51.4 %). More than half of respondents (55.8 % ) believe that the personsuffering from tuberculosis would try to hide it ill of those who surround without big differences

depending on age , sex , place of residence , education or socioeconomic status . As for the reasons forconcealment , fear of losing friends is 94 % in answers; fear of being avoided by people around you ( 92% ) fear that no one will want to marry the sick person is 88 % and the fear of lose their jobs - 84 % . Onthe other hand , most respondents (75.8 % ) would agree to take home a relative who contractedtuberculosis , was treated in hospital and should continue outpatient treatment at home . Of these, almosthalf of respondents (47.2 %) would receive this relative to their home until definitive treatment if theperson is a close relative . Almost one fifth (18.5 %) would refuse to care for a relative , and 6% would bequestioned whether or not home to receive a person with tuberculosis until his final treatment . And thistime , those who refuse to care for a person close outpatient phase are higher proportion of rural people(21.6 % versus 7.5 % in cities ) , women (21.9 % compared 14.6 % men) and lower educational level (24.3% to 13.9 % higher than faq ) and lower socioeconomic status (20.6 % lower than the 11.3% level) .