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Organization of detection of tuberculosis patients
Last reviewed: 06.07.2025

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Identification of patients with tuberculosis is a systematic, specifically organized and supported by regulatory documents activity of healthcare institutions aimed at identifying individuals with suspected tuberculosis with their subsequent examination to confirm or exclude this diagnosis.
Identification of patients upon treatment
One of the priority areas in the system of anti-tuberculosis measures in modern conditions is the detection of tuberculosis in health care institutions of various profiles among persons seeking medical care. The detection of tuberculosis patients among those seeking medical care in general medical network institutions is carried out by employees of these institutions.
The following patients are subject to examination:
- with symptoms of inflammatory bronchopulmonary disease (respiratory symptoms):
- the presence of a prolonged cough (more than 2-3 weeks) with the release of sputum:
- hemoptysis and pulmonary hemorrhage;
- chest pain associated with breathing;
- with intoxication symptoms persisting for more than 2-3 weeks:
- increase in body temperature;
- weakness;
- increased sweating, especially at night;
- weight loss.
In a healthcare facility of any profile, all individuals with symptoms of respiratory disease undergo:
- clinical examination: study complaints, anamnesis, conduct a physical examination;
- laboratory testing: sputum (if available) is examined three times under a microscope for acid-fast mycobacteria using Ziehl-Neelsen staining;
- X-ray examination of the chest organs in the volume accessible to the institution (the optimal option is the use of digital fluorography). Most patients with infectious forms of tuberculosis have symptoms of the disease. Therefore, microscopic examination of sputum in people who seek medical attention with complaints suspected of tuberculosis is the fastest way to identify epidemically dangerous patients. The first and second sputum samples are taken in the presence of a health worker on the day of the patient's visit (with an interval of 1.5-2 hours), then he is given a container to collect morning sputum before the second visit to the doctor.
If the patient lives far from the medical facility or is in poor condition, he is hospitalized for 2-3 days for examination.
In remote settlements, it is necessary to train paramedics and other medical workers in the technique of collecting and preserving sputum. In therapeutic, pulmonary and other hospitals of health care institutions of any profile, where patients with acute and chronic inflammatory diseases of the respiratory system are admitted, microscopy of sputum smears stained according to Ziehl-Neelsen is a mandatory component of the examination. The collected sputum must be delivered to the laboratory as soon as possible. If this is not possible, the material is stored in a refrigerator at an air temperature of 4-10 C. If the laboratory is located far from the health care institution, the delivery of material for research is carried out 1 or 2 times a week.
In the absence of acid-fast mycobacteria in all three examined sputum smears, but the presence of clinical and radiographic signs of inflammation in the lungs, test therapy can be performed for up to 2 weeks with broad-spectrum antibiotics. In this case, drugs with anti-tuberculosis activity (streptomycin, kanamycin, amikacin, capreomycin, rifampicin, rifabutin, fluoroquinolones, etc.) should not be used. If antibacterial therapy is ineffective, the patient should be referred to an anti-tuberculosis institution.
If the necessary equipment is available in healthcare institutions of any profile, primarily in therapeutic and pulmonology hospitals, instrumental research methods should be used for morphological, cytological and microbiological confirmation of the diagnosis of tuberculosis. Invasive studies are carried out in a hospital setting or, if possible, in a one-day hospital, day hospital or other hospital-substituting conditions.
The scope of examination of a patient with suspected tuberculosis is determined by the need to obtain reliable confirmation or exclusion of the diagnosis of tuberculosis. If it is impossible to provide the necessary examinations in a given institution, the patient should be referred to a healthcare institution where such an opportunity exists.
At feldsher-midwife stations, outpatient clinics, district hospitals, and polyclinics, complaints and anamnesis should be collected and analyzed, sputum smear microscopy with Ziehl-Neelsen staining should be performed three times to detect acid-fast mycobacteria, general blood and urine tests should be performed, and for children and adolescents, a Mantoux tuberculin test should be performed.
At the level of a municipal hospital, these studies should be supplemented by an X-ray (fluorographic) examination of the patient and the necessary consultations with specialists in extrapulmonary pathology, if indicated (neurologist, urologist, orthopedic surgeon, gynecologist, ophthalmologist, etc.).
In regional, territorial, republican and federal institutions, the examination may be supplemented by high-tech methods of radiation diagnostics (computer tomography, magnetic resonance imaging, positron emission tomography), endoscopic examinations, immunological and special examination methods by specialists in extrapulmonary pathology, cytological and histological examination of biopsy specimens. In large hospitals and clinics of therapeutic, pulmonological and surgical profiles, molecular genetic methods of detecting mycobacteria tuberculosis, high-tech invasive methods of surgical diagnostics may also be used according to indications.
If the results of examination in healthcare institutions of any profile are positive or questionable, the patient is referred to an anti-tuberculosis institution to confirm or exclude the diagnosis of tuberculosis and register the patient.
To assess the level of organization of timely detection of tuberculosis patients, the following indicators and criteria are used:
- coverage of the population with screening examinations (should be 60-70% of the population living in a given territory);
- the proportion of patients with active tuberculosis identified during screening examinations among all those registered for the first time (70-75%);
- the proportion of patients actively identified by sputum smear microscopy among all newly identified patients with respiratory tuberculosis - untimely detection (no more than 10%);
- the proportion of patients with fibro-cavernous tuberculosis among newly diagnosed patients (no more than 1-1.5%);
- the proportion of patients who died from tuberculosis in the first year of observation, among all those who died from tuberculosis;
- the proportion of patients with a posthumous diagnosis among all those who died from tuberculosis (5%) and among all those registered for the first time (1%).
Active detection of tuberculosis patients
In Russia, active detection of tuberculosis is usually understood as detection of patients during examinations conducted regardless of the presence or absence of signs of tuberculosis. Active detection of tuberculosis is carried out during mass screening examinations (traditionally called "preventive"), during examination of risk groups or during examination of individuals who have sought medical attention for any disease and present complaints not related to the tuberculosis process.
The heads of medical institutions are responsible for the work on timely active detection of tuberculosis patients. Control over the detection of tuberculosis patients is carried out by the heads of municipal health authorities and Rospotrebnadzor. Organizational and methodological assistance is provided by employees of anti-tuberculosis institutions.
For many years, the basis for active detection of respiratory tuberculosis in adults in Russia was the fluorographic method of examination, conducted on the entire population every 1-2 years. Mass fluorographic examinations covered the majority of the population and made it possible to identify patients with respiratory tuberculosis at relatively early stages of the disease, mainly with limited processes, slightly expressed clinical manifestations of the disease or with their complete absence.
The system of active detection of tuberculosis patients is currently undergoing a period of modernization and transition to new organizational technologies and research methods.
In modern conditions, the priority is recognized as active detection of tuberculosis among those population groups where tuberculosis is most frequently detected - in the so-called high-risk groups for tuberculosis. In this case, all available methods for detecting tuberculosis can be used.
Three research methods are used to actively identify patients with tuberculosis:
- radiation (mainly fluorographic method, preferably using digital X-ray equipment). This method is used to detect tuberculosis in adults and adolescents;
- microbiological examination of sputum and urine in individuals with symptoms of respiratory and renal diseases. Used to examine adults, adolescents, and, less frequently, children;
- tuberculin diagnostics. Used as a screening method for examining children and, to some extent, adolescents.
The main method of detecting tuberculosis is the fluorographic examination. During screening fluorographic examinations, pulmonary forms of tuberculosis are detected at early stages, when symptoms of the disease (subjective and objective) are absent or poorly expressed. The microbiological method of sputum examination is a very important additional method of detecting patients with infectious forms of tuberculosis.
The following population groups are subject to examination twice a year:
- military personnel serving by conscription;
- employees of maternity hospitals (departments);
- persons in close household or professional contact with sources of tuberculosis infection;
- persons removed from the dispensary register at specialized anti-tuberculosis treatment and prevention institutions due to recovery - during the first 3 years after removal from the register;
- persons who have had tuberculosis and have residual changes in the lungs - during the first 3 years from the moment the disease was detected;
- HIV-infected;
- patients registered with drug treatment and psychiatric institutions;
- persons released from pre-trial detention facilities and correctional institutions - during the first 2 years after release;
- defendants held in pre-trial detention facilities and convicted persons held in correctional institutions.
The following population groups are subject to examination once a year:
- patients with chronic non-specific diseases of the respiratory system, gastrointestinal tract, genitourinary system;
- patients with diabetes:
- persons receiving corticosteroid, radiation and cytostatic therapy;
- persons belonging to social groups at high risk of developing tuberculosis:
- homeless;
- migrants, refugees, forced migrants;
- residents of stationary social service institutions and social assistance institutions for persons without a fixed abode and occupation;
- persons working:
- in social service institutions for children and adolescents;
- in medical and preventive, health resort, educational, health and sports institutions for children and adolescents.
The following are subject to extraordinary medical examinations to detect tuberculosis:
- persons living together with pregnant women and newborns;
- citizens called up for military service or entering military service under contract;
- persons who have been diagnosed with HIV infection for the first time.
When analyzing the coverage of the population with examinations and the proportion of newly diagnosed patients with active tuberculosis, it is necessary to compare these indicators with the level of tuberculosis incidence in the population.
The reduction in the coverage of the population with screening examinations and the decline in the quality of these examinations created the illusion of well-being, which did not allow for the timely development of appropriate measures to improve the detection of tuberculosis patients.
In 2005, 51,594 patients with active tuberculosis were identified during screening examinations.
Thus, without the use of the fluorographic method, about half of newly diagnosed tuberculosis patients (49.5%) would remain unknown, and treatment and preventive measures for them and those around them would not have been carried out. Analysis of the results of bacteriological research methods for the active detection of tuberculosis patients indicates their insufficient use and the need to improve work in this area.
The effectiveness of fluorographic examinations depends on:
- full registration of persons subject to examination and planning of their examination;
- organization of examinations in fluorography rooms;
- organizing examination of individuals with identified changes.
Planning, organization and reporting of examinations are provided by the heads of medical and preventive institutions based on the data of individual registration of the population according to the territorial or territorial-production principle. Examinations are carried out in fluorography rooms of polyclinics, hospitals, anti-tuberculosis dispensaries at the place of residence, at the place of work, when seeking medical care. It is very important to take into account all data on a territorial scale for statistical and medical processing, which is possible with the presence of a unified information system. The system should be available to medical institutions for repeated examinations of patients. The introduction of such a system will allow:
- reduce radiation exposure to patients;
- eliminate duplication of examinations;
- use the opportunity of retrospective study of radiological examinations of previous years, reduce the time of diagnosis and, as a result, begin adequate therapy at an earlier stage;
- identify the tuberculosis process at the early stages of development, which will increase the effectiveness of treatment and lead to a reduction in mortality;
- to create a database for scientific analysis of trends in the development of the tuberculosis process and the exchange of information.
In addition to tuberculosis, screening fluorographic examinations reveal post-tuberculous changes, lung cancer, metastatic lung lesions, benign tumors, sarcoidosis, pneumoconiosis, pulmonary emphysema, pneumofibrosis, pleural layers, adhesions, calcifications, mediastinal pathology, cardiac pathology, spinal scoliosis, developmental variants and pathological changes in the ribs, etc.
The rapid development of digital technologies in X-ray diagnostics over the past 10 years has made it possible to reduce the patient's radiation dose many times over and use all the advantages of computer image processing. The active introduction of digital X-ray equipment into practical healthcare has dramatically changed the attitude to the status of fluorographic examinations and increased the diagnostic capabilities of the method for detecting tuberculosis and other lung diseases. It is gratifying to note that the domestic industry can already provide the country with good-quality digital fluorographs. At the same time, their cost is 4-5 times lower than the cost of foreign analogues.
A new stage in the improvement of digital technologies in X-ray diagnostics is considered to be the creation of low-dose digital devices of the next generation with high resolution (from 2.3 pairs of lines per 1 mm and higher), allowing not only to detect changes in the lungs, but also to diagnose tuberculosis in the early stages.
[ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]
Detection of tuberculosis in children and adolescents
A characteristic feature of tuberculosis in children is the involvement of the entire lymphatic system in the pathological process, mainly the intrathoracic lymph nodes, and the slow involution of specific changes in them. Localization of the pathogen in the lymphatic system is one of the reasons limiting the possibility of bacteriological confirmation of the diagnosis (at least 90% of children and 50% of adolescents with newly diagnosed tuberculosis of the lungs and intrathoracic lymph nodes are not excretors of bacteria). In these cases, the diagnosis of tuberculosis is based on a combination of anamnesis data, tuberculin diagnostics results, clinical and radiological data and laboratory test results.
The choice of research methodology is determined by the biological age characteristics of the child and adolescent contingent and, as a consequence, the characteristics of the course of tuberculosis infection in a child. The tasks of general medical and preventive network doctors at the site, in children's institutions (nursery-kindergarten, school), general practitioners, family doctors include mass tuberculin diagnostics, anti-tuberculosis vaccination of newborns not vaccinated in the maternity hospital, BCG revaccination.
Detection of tuberculosis when seeking medical care
When seeking medical help, tuberculosis is detected in 40-60% of older children and adolescents, and in the vast majority of children in their first year of life. As a rule, the most common and severe forms are detected. Almost all young children with tuberculosis are first admitted to general somatic departments with diagnoses such as pneumonia, acute respiratory viral infection, and meningitis. If there is no positive dynamics during treatment, tuberculosis is suspected, after which children are hospitalized in specialized children's tuberculosis departments.
Adolescents (students in secondary specialized educational institutions, employed, unorganized) should be examined using the X-ray (fluorographic) method in the following cases:
- at any visit to a doctor, if fluorography was not performed in the current year;
- when visiting a doctor with symptoms that allow one to suspect tuberculosis (protracted pulmonary diseases (more than 14 days), exudative pleurisy, subacute and chronic lymphadenitis, erythema nodosum, chronic diseases of the eyes, urinary tract, etc.);
- before prescribing physiotherapy treatment;
- before prescribing corticosteroid therapy;
- Frequently and long-term ill adolescents are examined during periods of exacerbation, regardless of the timing of the previous fluorography.
Detection of tuberculosis during preventive examinations
Mass tuberculin diagnostics are carried out using the Mantoux reaction with 2 tuberculin units (TU) for children and adolescents vaccinated against tuberculosis. The test is done once a year starting from the age of one year. For children and adolescents not vaccinated against tuberculosis, the test is done once every 6 months starting from the age of 6 months until vaccination.
Fluorography is performed on teenagers at their place of work or study. For those working in small enterprises and unorganized ones - in polyclinics and PTDs.
Fluorography is performed on teenagers aged 15 to 17 years annually, and subsequently, according to the adult population examination scheme, at least once every 2 years. Fluorography is performed on teenagers who arrived at educational institutions from other regions of Russia and the CIS countries if it was not provided or more than 6 months have passed since it was performed.
Before the birth of the child, in the first 6 months of pregnancy, fluorography is performed on all persons who will live with the child in the same apartment.
Bacteriological studies for the diagnosis of tuberculosis are carried out if the child has:
- chronic respiratory diseases (sputum is examined);
- chronic diseases of the urinary system (urine is examined);
- meningitis (the cerebrospinal fluid is examined for mycobacterium tuberculosis and fibrin film).
Detection during examination by contact. When any case of active tuberculosis is detected (a sick person, a sick animal), children and adolescents who have been in contact with them are required to be referred for consultation to a phthisiatrician and observed in the anti-tuberculosis dispensary in the State Institution IV. Possible contacts:
- household (family, related);
- living in one apartment;
- living on the same landing;
- stay on the territory of a tuberculosis institution;
- living in families of livestock breeders who keep farm animals sick with tuberculosis or who work on farms with a high tuberculosis risk.
A pediatrician in a general outpatient treatment network must be able to identify children who are at risk for developing tuberculosis, carry out the necessary diagnostic and treatment-and-prophylactic measures for children in these groups, and correctly and systematically apply methods for identifying tuberculosis infection and preventing the development of the disease in childhood.
[ 16 ], [ 17 ], [ 18 ], [ 19 ]
Detection of tuberculosis in general medical care facilities
In general medical network institutions, primary differential diagnostics of tuberculosis with diseases of non-tuberculous etiology is carried out. For this:
- collect a history of tuberculin sensitivity for previous years and information on immunization with the BCG vaccine;
- conduct individual tuberculin diagnostics.
- children and adolescents are consulted by a phthisiatrician;
- On the recommendation of a phthisiatrician, clinical tuberculin diagnostics, X-ray examination, etc. are carried out.
Detection of tuberculosis in tuberculosis dispensaries
One of the tasks of the PTD is to organize the primary clinical examination of children and adolescents from risk groups for the development of tuberculosis (GDU 0, IV and VI). The mandatory diagnostic minimum of examinations conducted in the PTD conditions include:
- familiarization with the anamnesis and physical examination of children and adolescents at risk for developing the disease;
- individual tuberculin diagnostics;
- laboratory diagnostics (blood and urine tests);
- bacteriological diagnostics: fluorescent microscopy and culture of urine, sputum or throat swab for Mycobacterium tuberculosis (three times);
- X-ray and/or tomographic examination.
Outpatient observation
One of the most important areas of activity of anti-tuberculosis institutions is dispensary observation of patients. The forms and methods of dispensary work have changed over the many years of existence of anti-tuberculosis institutions. The principle of long-term (2-4 years) monitoring of the stability of cure after completion of complex therapy was the basis of all existing dispensary groups (1938, 1948, 1962, 1973, 1988, 1995).
Due to the decrease in the effectiveness of tuberculosis treatment, the increase in the number of bacteria excretors (by 3 times over the past 15 years), the principles of dispensary observation of contingents of anti-tuberculosis institutions were modified. The regulatory and legal basis for the new system of dispensary observation and registration of contingents of anti-tuberculosis institutions were the Federal Law "On the Prevention of the Spread of Tuberculosis in the Russian Federation", the Resolution of the Government of the Russian Federation on the implementation of this law No. 892 of December 25, 2001, and the order of the Ministry of Health of Russia No. 109 of March 2, 2003. Based on them, the principles of dispensary observation of contingents of anti-tuberculosis institutions were revised, the number of contingents registered was reduced by almost 1 million, and the attention of phthisiologists was focused on patients in need of treatment. The following principles form the basis of the new dispensary grouping:
- validity of determining the activity of the tuberculosis process and conducting differential diagnostics;
- the validity and timeliness of the decision on the clinical cure of tuberculosis;
- confirmation of the durability of the cure when observing patients in control groups;
- conducting anti-relapse treatment courses as indicated.
[ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ]
Adult outpatient observation and registration groups
There are several groups of dispensary observation (GDN) and registration (GDU) of adult contingents of anti-tuberculosis institutions.
Dispensary observation group 0 (GDN 0)
This group includes persons requiring diagnostics of the tuberculosis process activity (GDN 0A) and differential diagnostics (GDN OB). The disease is diagnosed both in patients who have applied to an anti-tuberculosis institution for the first time and in those who have been previously registered. The duration of the diagnostic period and the observation period in GDN 0 should be 2-3 weeks and no more than 3 months in case of test therapy.
After the end of the diagnostic period, if an active form of tuberculosis is determined, the patient is transferred to GDN I. If a non-tuberculous disease or inactive tuberculosis is detected, the patient is removed from the register and sent to a polyclinic with the appropriate recommendations. Persons registered in GDN III, IV, who have a need to determine the activity of existing changes, are not transferred to GDN 0. These issues are resolved during the examination and observation of such patients in the same registration group.
Dispensary observation group I (GDN I)
In GDN I, patients with active forms of tuberculosis are included: in subgroup IA - with newly diagnosed disease, in IB - with relapse of tuberculosis. Both subgroups are further divided into 2 depending on the presence of bacterial excretion in the patient: IA (MBT+), IA (MBT-), IB (MBT+) and IB (MBT-). In addition, in this group, subgroup IB is distinguished for patients who spontaneously interrupted treatment or were not examined in a timely manner at the end of the course of treatment (i.e. the treatment outcome remained unknown). The group for recording patients with tuberculosis of the respiratory organs is designated as IA TOD, the group for recording patients with tuberculosis with extrapulmonary and localizations - IA TVL.
The issue of registering newly diagnosed tuberculosis patients and removing them from the register is decided by the Central VKK or the Clinical Expert Commission based on the presentation of a phthisiatrician or the relevant specialist of the anti-tuberculosis institution (tuberculosis department). The duration of observation in the GDN I is determined by the time of disappearance of signs of active tuberculosis of the respiratory organs, but it should not exceed 24 months from the date of registration. After the disappearance of signs of active tuberculosis, the treatment is considered complete and effective, and the patient, as clinically cured, is transferred to the GDN III for subsequent monitoring of the stability of the cure and the justification for his transfer to group III.
Dispensary observation group II (GDN II TOD, GDN II TVL)
In GDN II, patients with active forms of tuberculosis with a chronic course of the disease, mainly with bacterial excretion and destructive changes, are observed. The group includes 2 subgroups. In subgroup IIA, patients who need intensive treatment are observed, with the help of which it is possible to achieve clinical cure and transfer the patient to GDN III. Subgroup BP includes patients with an advanced process, requiring general strengthening, symptomatic treatment and periodic (if indicated) anti-tuberculosis therapy. The observation periods in GDN II are not limited.
Chronic course of active forms of tuberculosis is a long-term (more than 2 years) wave-like (abatement, exacerbation) course of the disease, in which clinical, radiological and bacteriological signs of the activity of the tuberculosis process persist. Chronic course of active forms of tuberculosis occurs due to late detection of the disease, inadequate and unsystematic treatment, features of the immune state of the body or the presence of concomitant diseases that complicate the course of tuberculosis.
Transfer of patients who have completed the course of treatment without destructive changes and bacterial excretion from GDN I to GDN II is not permitted. to confirm the stability of the cure. This is the fundamental difference between GDN II of the new monitoring system and the previous one.
Dispensary registration group III (GDU III TOD. GDU III TVL)
In GDU III (control), individuals cured of tuberculosis are taken into account, with major and minor residual changes or without them. GDU III is a group with a high risk of developing a relapse of tuberculosis. In this group, the stability of clinical cure and the validity of this diagnosis are monitored after completion of observation in GDU I and II.
The observation period depends on the magnitude of residual changes and aggravating factors, including concomitant diseases. The observation period for individuals with large residual changes in the presence of aggravating factors is 3 years, with small residual changes without aggravating factors - 2 years, without residual changes - 1 year.
In recent years, an increase in the reactivation of tuberculosis has been observed in patients of GDU III. The increase in the number of relapses occurs, on the one hand, due to an incorrect assessment of the activity of the process (cure) upon transfer to GDU III, and on the other hand, due to the actual reactivation of the disease. In this regard, it is advisable to increase the observation period in GDU III to 5 years.
Dispensary registration group IV (DRG IV)
GDU IV includes persons in contact with patients with tuberculosis. The group is divided into 2 subgroups. Subgroup IVA includes persons in household contact (family, relatives, apartment) with a patient with active tuberculosis with established and unestablished bacterial excretion. The observation period in this group is limited to one year after the end of effective treatment of the patient with tuberculosis, stay in the focus or after the death of the patient from tuberculosis. These persons undergo two courses of chemoprophylaxis lasting 3 months during the first year after the detection of the source of infection. A comprehensive examination of persons in contact with a patient with tuberculosis is carried out 2 times a year.
Subgroup IVB includes persons who have professional and industrial contact with people and animals sick with tuberculosis, as well as all persons who have contact with bacteria excretors at their place of work. The duration of stay in the IVB GDU is determined by the period of work in conditions of occupational hazards and industrial contact plus 1 year after its termination. A comprehensive control examination is carried out at least once a year. Persons included in this GDU are recommended general health measures (preferably in a sanatorium or rest home). Chemoprophylaxis of tuberculosis is carried out according to indications.
Groups for dispensary observation and registration of children
This grouping is uniform for young children, older children and teenagers. The contingents of children and teenagers subject to registration at the dispensary are divided into 5 main groups.
Zero group (0)
The zero group monitors children and adolescents referred 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.
First group (I)
Group I includes patients with active forms of tuberculosis of any localization. The group is divided into 2 subgroups:
- subgroup IA. It includes patients with widespread and complicated tuberculosis;
- subgroup IB, including patients with minor and uncomplicated forms of tuberculosis.
Second group (II)
Group II includes patients with active forms of tuberculosis of any localization and chronic course of the disease. Patients can be observed in this group with continuation of treatment (including individual) and for more than 24 months.
Third group (III)
Group III includes children and adolescents at risk of relapse of tuberculosis of any localization. It includes 2 subgroups:
- subgroup IIIA. It includes newly diagnosed patients with residual post-tuberculosis changes;
- subgroup IIIB, which includes persons transferred from groups I and II, as well as subgroup IIIA.
Fourth group (IV)
The fourth group includes children and adolescents who are in contact with sources of tuberculosis infection. The group is divided into 2 subgroups:
- subgroup IVA. This includes individuals who are in family, relative and residential contacts with bacteria carriers, as well as in contacts with bacteria carriers in children's and adolescent institutions; children and adolescents living on the territory of tuberculosis institutions:
- Subgroup IVB. It includes individuals who have been in contact with patients with active tuberculosis without bacterial excretion; those living in families of livestock breeders who work on farms with a high tuberculosis risk, as well as in families that keep farm animals with tuberculosis.
Fifth group (V)
The fifth group includes children and adolescents with complications after anti-tuberculosis vaccinations. Three subgroups are distinguished:
- subgroup VA, which includes patients with generalized and widespread lesions;
- subgroup VB, which includes patients with local and limited lesions;
- subgroup VB. It includes individuals with inactive local complications, both newly identified and those transferred from subgroups VA and VB.
Sixth group (VI)
The sixth group includes people with an increased risk of developing local tuberculosis. It includes 3 subgroups:
- subgroup VIA, which includes adolescents and adolescents in the early period of primary tuberculosis infection (turn of tuberculin reactions):
- subgroup VIB. It includes previously infected children and adolescents with a hyperergic reaction to tuberculin;
- subgroup VIB, which includes children and adolescents with increasing tuberculin sensitivity.
Definitions used in dispensary observation and recording of tuberculosis activity
Tuberculosis of doubtful activity. This term refers to tuberculosis changes in the lungs and other organs, the activity of which is unclear.
Active tuberculosis. Active tuberculosis is a specific inflammatory process caused by mycobacteria tuberculosis and determined by clinical, laboratory and radiation (radiological) signs. Patients with active tuberculosis require treatment, diagnostic, anti-epidemic, rehabilitation and social measures.
The issue of registering newly diagnosed tuberculosis patients and removing them from the register is decided by the Central VKK (KEK) based on the submission of a phthisiatrician or the relevant specialist of the anti-tuberculosis institution (tuberculosis department). The anti-tuberculosis institution notifies the patient of being placed under dispensary observation and of termination of observation in writing, with a completed notification. The notification dates are recorded in a special journal.
Clinical cure is the disappearance of all signs of active tuberculosis as a result of the main course of complex treatment. Criteria for the effectiveness of treatment of patients with tuberculosis:
- disappearance of clinical and laboratory signs of tuberculous inflammation;
- persistent cessation of bacterial excretion, confirmed by microscopic and cultural studies;
- regression of residual radiological manifestations of tuberculosis against the background of adequate therapy over the past 2 months.
Polyresistance of the pathogen is the resistance of Mycobacterium tuberculosis to any two or more anti-tuberculosis drugs, except for simultaneous resistance to isoniazid and rifampicin.
Multiple drug resistance of the pathogen is the resistance of Mycobacterium tuberculosis to the action of both isoniazid and rifampicin, regardless of the presence or absence of resistance to any other anti-tuberculosis drugs.
Monoresistance of the pathogen is the resistance of Mycobacterium tuberculosis to one (any) anti-tuberculosis drug.
An epidemic focus (focus of a contagious disease) is the location of the source of infection and the surrounding territory, within which the spread of the infectious agent is possible. Persons in contact with the source of infection are considered to be those who are in contact with the excretor of bacteria. An epidemic focus is taken into account at the actual place of residence of the patient. Anti-tuberculosis institutions (departments, offices) are also considered a focus of tuberculosis infection. On this basis, employees of anti-tuberculosis institutions are classified as persons in contact with excretors of bacteria and are accounted for under GDU IVB.
Bacterial excretors are patients with an active form of tuberculosis, in whom Mycobacterium tuberculosis is found in biological fluids and/or pathological material excreted into the external environment. Patients with extrapulmonary forms of tuberculosis are classified as bacterial excretors if Mycobacterium tuberculosis is found in their fistula discharge, urine, menstrual blood or discharge from other organs. Such patients are considered bacteriologically dangerous to others. Patients who have Mycobacterium tuberculosis growth during puncture, biopsy or surgical material culture are not considered bacterial excretors.
Patients are registered as bacteria excretors in the following cases:
- if there are clinical and radiological data indicating the activity of the tuberculosis process. In this case, the patient is registered even if Mycobacterium tuberculosis is detected once:
- in case of 2-fold detection of mycobacteria tuberculosis by any method of microbiological examination in the absence of clinical and radiological signs of an active tuberculosis process. In this case, the source of bacterial excretion may be endobronchitis, breakthrough of a caseous lymph node into the lumen of the bronchus or decay of a small lesion that is difficult to determine by radiological method, etc.
A single detection of Mycobacterium tuberculosis in patients of the III State Dispensary 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 a hospital setting in order to establish the source of bacterial excretion and the presence or absence of relapse of tuberculosis.
Each patient with tuberculosis should have their sputum (bronchial washings) and other pathological discharge thoroughly examined at least 3 times by bacterioscopy and culture before the start of treatment. Control microbiological and radiological examinations are carried out within a month from the start of treatment and are repeated once every 2-3 months until the end of observation in the State Dental Clinic I.
Cessation of bacterial excretion (abacillation) - the disappearance of tuberculosis mycobacteria from biological fluids released into the external environment and pathological discharge from the patient's organs, confirmed by two negative consecutive (bacterioscopic and cultural) studies with intervals of 2-3 months after the first negative analysis.
In the event of destructive tuberculosis in filled or sanitized cavities (including after thoracoplasty and cavernotomy), patients are removed from epidemiological records 1 year after the disappearance of bacterial excretion.
The issue of registering patients as bacteria excretors and removing them from this register is decided by the Central VKK (KEK) upon the presentation of the attending physician with the sending of a corresponding notification to the Rospotrebnadzor center.
Residual post-tuberculosis changes - dense calcified foci and foci of varying sizes, fibrous-scarring and cirrhotic changes (including with residual sanitized cavities), pleural layers, postoperative changes in the lungs, pleura and other organs and tissues, functional deviations determined after clinical cure has been established.
Minor residual changes - single (up to 3 cm), small (up to 1 cm), dense and calcified foci, limited fibrosis (within 2 segments). Major residual changes - all other residual changes.
Destructive tuberculosis is an active form of the tuberculosis process with the presence of tissue decay, determined using radiation methods of examination. The main method for identifying destructive changes in organs and tissues is considered to be radiation examination (X-ray: survey radiographs in direct and lateral projections, various types of tomography, etc.). In addition, in tuberculosis of the genitourinary organs, ultrasound examination (US) is of great importance. Closure (healing) of the decay cavity is its disappearance, confirmed by tomographic and other methods of radiation diagnostics.
Progression is the appearance of new signs of an active tuberculosis process after a period of improvement or an increase in existing signs of the disease when observed in GDN I and II before a diagnosis of clinical cure is established. In the case of exacerbation and progression of tuberculosis, patients are observed in the same dispensary registration groups in which they were (GDN I, II). The occurrence of an exacerbation or progression indicates unsuccessful treatment and requires its correction.
Relapse is the appearance of signs of active tuberculosis in individuals who have previously suffered from this disease and were cured of it during observation at the GDU III or were removed from the register due to recovery. These patients are not considered to be newly diagnosed patients with tuberculosis. Reactivation of tuberculosis that occurs in individuals who have spontaneously recovered and were not previously registered at anti-tuberculosis dispensary institutions is considered a new case of the disease.
The main course of treatment for patients with tuberculosis is a complex of treatment measures, including intensive and supportive phases and aimed at achieving clinical cure of the active tuberculosis process. The main method of treatment is combined drug therapy with anti-tuberculosis drugs: simultaneous administration of several anti-tuberculosis drugs to the patient according to approved standard schemes and individual correction. If there are indications, surgical methods of treatment should be used.
Aggravating factors are factors that contribute to a decrease in resistance to tuberculosis infection, aggravation of the tuberculosis process and a slowdown in recovery. Aggravating factors include:
- medical factors: non-tuberculous diseases, pathological conditions, bad habits;
- social factors: stress, income below the subsistence level, poor housing conditions, increased workload;
- professional factors: constant contact with sources of tuberculosis infection.
Aggravating factors are taken into account when observing patients in registration groups, when choosing the form of treatment organization and when carrying out preventive measures:
Formulation of diagnoses. When registering a patient with active tuberculosis (GDN I), the diagnosis is formulated as follows: the disease (tuberculosis) is named, the clinical form, localization, phase, and presence of bacterial excretion are indicated. For example:
- tuberculosis, infiltrative, of the upper lobe of the right lung (S1, S2) in the phase of decay and dissemination, MBT+;
- tuberculous spondylitis of the thoracic spine with destruction of the vertebral bodies TVIII-IX, MBT-;
- tuberculosis of the right kidney, cavernous, MBT+.
When transferring a patient to GDN II (patients with chronic tuberculosis), the clinical form of tuberculosis that is observed at the time of transfer is indicated. For example, if at registration there was an infiltrative form of tuberculosis, and with an unfavorable course of the disease, fibrous-cavernous tuberculosis of the lungs has developed (or a large tuberculoma with or without decay remains), the fibrous-cavernous form of tuberculosis of the lungs (or tuberculoma) should be indicated in the transfer medical report.
When transferring a patient to the control group (GDU III), the diagnosis is formulated as follows: “clinical cure of one or another form of tuberculosis (the most severe diagnosis during the period of illness is given) with the presence of (major, minor) residual post-tuberculosis changes in the form of (the nature and prevalence of changes are indicated)”. For example:
- clinical cure of disseminated pulmonary tuberculosis with the presence of large residual post-tuberculous 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 a condition after economical resection of the upper lobe (S1, S2) of the right lung.
For patients with extrapulmonary forms of tuberculosis, diagnoses are formulated according to the same principle. For example:
- clinical cure of tuberculous coxitis on the right with partial impairment of joint function;
- clinical cure of cavernous tuberculosis of the right kidney.