Phthisiatrist

It has been scientifically proven that a third of the inhabitants of our planet are carriers of the tuberculosis bacteria, and every second a new patient with tuberculosis is discovered. Agree, this is a fairly common infection. That is why the doctor who deals with all issues related to tuberculosis is singled out as a separate specialty - a phthisiologist.

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Who is a phthisiatrician?

This is the specialty of a doctor with a higher medical education who studies various measures of prevention, diagnostics and treatment of all possible forms of tuberculosis. Such a specialist is competent in the issues of causes of development, mechanisms of transmission of tuberculosis infection, the course of pathological processes. He carries out preventive, epidemiological, therapeutic and rehabilitation measures, as well as the necessary diagnostic procedures.

When should you see a TB specialist?

You should contact a phthisiatrician if you have had contact with a patient with tuberculosis, if the tuberculin test result is positive, or if suspicious symptoms appear that suggest the presence of the disease.

Adults, unfortunately, may not pay attention to the signs of the disease for a long time. The pathology is discovered in them by chance, during a routine X-ray examination. However, a phthisiatrician recommends contacting him for a consultation if the following symptoms are present:

• rapid fatigue, increasing towards evening;
• poor appetite;
• unnatural sweating, regardless of the time of day;
• sudden and significant weight loss;
• pain in the interscapular region;
• constant coughing fits, dry or with translucent foamy sputum, in advanced cases hemoptysis; coughing intensifies when trying to take a deep breath, after shouting or a long conversation;
• increasing hoarseness and pain when swallowing, heavy breathing;
• cyclical increase in temperature.

In addition, you can contact a phthisiatrician for consultations and interpretation of an X-ray image of the lungs.

What tests should you take when visiting a phthisiatrician?

Immediately before visiting a phthisiatrician, it is recommended to undergo a chest X-ray. Women should visit a gynecologist. The phthisiatrician himself will prescribe other necessary tests and examinations, if necessary.

If you have already undergone any tests for reasons related to suspected tuberculosis infection, take the results of the tests and examinations with you so that your doctor can evaluate them and present a complete picture of your condition.

What diagnostic methods does a phthisiatrician use?

Laboratory diagnostic methods used by a phthisiologist include bacteriological and bacterioscopic analyses, biological and allergic reactions. Sometimes serological studies may be used.

For microscopy, bacteriology or biological samples, those materials are used that are directly related to the localization of the tuberculosis focus. These can be pus particles, urine samples, salivary and cerebrospinal fluid, fecal excrements collected in a special container.

• Homogenization procedure: the daily amount of sputum secreted by the patient is collected in a container, the same amount of 1% caustic soda solution is added, sealed and shaken vigorously for 10-15 minutes. The resulting mixture is processed in a centrifuge, after which the denser layer is neutralized by adding 2 drops of 10% hydrochloric or 30% acetic acid. The preparation is used in the form of smears and Ziehl-Neelsen staining.
• Flotation procedure: the daily volume of sputum prepared and shaken in the same way is kept for half an hour in a water bath at a temperature of 55°C. After this, 1-2 ml of benzene (or gasoline) is added and shaken again. The resulting mixture should be left to stand at a temperature of 22-24°C: during this time, the benzene particles rise to the top, capturing the microbial flora. This layer is separated and placed on a section of the slide, which is placed on an additional glass heated to 60°C. The material is applied in several layers and subjected to fixation and staining according to Ziehl-Neelsen.
• Bacteriology: a successful technique that is actively used when bacterioscopy has proven negative. Two volumetric doses of 6% sulfuric acid are added to the collected material and shaken for about 10 minutes. After that, the mixture is processed in a centrifuge in special containers, the denser lower layer is separated and subjected to a neutralization reaction using 3% caustic soda. If feces are being examined, they are processed with 4% caustic soda, the material is placed in a thermostat, processed, and the dense layer is processed with 8% hydrochloric acid. Subsequently, the preparation can be seeded on special media.

Such test preparations as, for example, a sample of spinal cerebrospinal fluid, particles of purulent discharge, blood elements are not pre-treated. They are applied to nutrient media and kept in a thermostat for 2 months. The first colonies can be detected after 10-30 days.

• Deep growth study: the discharge is seeded in a container with citrated blood. After a week, the medium is placed in a centrifuge and a smear is made from the dense lower layer.
• The allergological method is used to detect tuberculosis mycobacteria themselves. A tuberculin injection is performed, which can confirm the presence of infection, but will not provide characteristics of the process itself. Such methods include the intradermal Mantoux test and the Pirquet skin reaction.
• Serological testing is a process of the Bardet-Gengou complement linkage reaction. It is not used often.

The most modern and fast method used by phthisiologists is considered to be fluorescent microscopy. The material is stained with auromin at a rate of 1:1000. After that, the color is removed with hydrochloric alcohol and stained again with fuchsin. As a result, tuberculosis bacilli will glow with a light green-golden hue against a darker background.

What does a phthisiatrician do?

Tuberculosis dispensaries, hospitals, phthisiology offices, specialized sanatoriums - these are the places where a phthisiologist works. In such institutions, you can get his advice or help related to issues of timely detection, treatment and implementation of preventive measures that reduce the risk of tuberculosis.

Unfortunately, the presence of significant and numerous cavernous tuberculous formations, advanced stage of tuberculosis are not always successfully treated with the help of phthisiology. Such pathological changes of lung tissue and bronchi are usually cured exclusively by surgery. In such cases, the patient can be referred by the phthisiologist to a thoracic surgeon.

Let's summarize the main areas of activity of a phthisiatrician:

• prevention of epidemics and the spread of tuberculosis infection;
• providing anti-tuberculosis assistance, conducting explanatory work among the population;
• genetic, immunological and immunomorphological issues of tuberculosis infection;
• biochemical processes in the etiology of tuberculosis;
• implementation of treatment measures, introduction of new technologies in therapeutic methods for tuberculosis.

What diseases does a phthisiatrician treat?

Tuberculosis is a serious and dangerous disease that can affect almost all organs and systems of the human body. Most often, tuberculosis affects the respiratory system. However, damage to other organs is also quite common: this is why a TB doctor closely cooperates with other specialists - a pulmonologist, dermatologist, ophthalmologist, orthopedist, etc. A TB doctor treats any form of tuberculosis, including the following pathologies:

• disseminated form of tuberculosis of the lungs;
• infiltrative form of tuberculous pulmonary disease;
• focal form of pulmonary tuberculosis;
• cavernous form of pulmonary tuberculosis;
• diagnosed pulmonary tuberculoma;
• tuberculous eye lesions, keratitis, conjunctivitis, diffuse forms of tuberculous uveitis (iritis, iridocyclitis);
• metastatic tuberculous lesion of the eye;
• indurative form of tuberculous skin lesion (tuberculous erythema);
• colliquative form of cutaneous tuberculosis (manifestations of scrofuloderma);
• lichenoid form of cutaneous tuberculosis (scrofulous lichen);
• papulonecrotic form of cutaneous tuberculosis;
• warty form of tuberculous skin lesions;
• miliary-ulcerative form of tuberculous lesions of the skin and mucous membranes;
• lupus tuberculosis skin lesion;
• manifestations of tuberculous mesadenitis;
• tuberculous lesions of the bronchi and trachea;
• tuberculous bronchoadenitis;
• tuberculosis of the nose, oral cavity and nasopharynx;
• tuberculous bowel disease;
• tuberculous lesion of the esophagus;
• tuberculous lesions of the prostate and testicles;
• tuberculous inflammation of the meninges;
• tuberculous lesions of bones and joints (musculoskeletal system);
• urogenital form of tuberculosis (damage to the uterus, appendages, cervix and vagina, urethra, bladder);
• tuberculous kidney disease.

Advice from a phthisiatrician

To ensure that tuberculosis bypasses you and your family, listen to the recommendations of a TB specialist:

• Consult a doctor if you experience a regular cough, chest pain, increased sweating, and difficulty breathing;
• If you have had contact with a tuberculosis patient, consult a doctor for prevention and examination;
• undergo medical examinations regularly, once every two years (in educational institutions and at work, at your place of work) with mandatory x-rays;
• Some categories of the population should undergo medical examinations up to 2 times a year. These categories include active military personnel, maternity ward health workers, people in constant contact with tuberculosis patients, patients who have recovered from tuberculosis, AIDS patients, and former prisoners;
• lead a healthy lifestyle, exercise, eat healthy, balanced food;
• refrain from smoking and drinking alcohol;
• regularly ventilate production and domestic premises, observe the rules of public and personal hygiene;
• treat acute and chronic pathologies in the body in a timely manner;
• Avoid buying dairy products that have not been tested by the sanitary and epidemiological station. Such products may be obtained from a cow with tuberculosis.

A phthisiologist is a very interesting, necessary and sought-after medical specialty. This doctor bears great responsibility for the health and full life of people, does everything possible to prevent the development of a tuberculosis epidemic - one of the most ancient infections, which is dangerous even today.