Dispensary registration groups for tuberculosis help to monitor a sick person at different stages of the pathology. If a person has been diagnosed with such a disease, in any case, he is registered in the TB dispensary. In such an institution, the patient is registered either until the disease is completely cured, or until the end of life, depending on the nature of its course.
Therapy in the TB dispensary is completely voluntary, free of charge, provided at the expense of the state budget. The only exception is an open form of the disease, a medical examination of a person with which is required by a court order.
A tuberculosis dispensary is a medical institution that has in its structure inpatient and outpatient departments, as well as a physiotherapy department. Diagnosis of tuberculosis is carried out in special rooms that contain an x-ray machine, devices for microbiological and clinical research, as well as endoscopy. Some anti-tuberculosis institutions have a sanatorium.
The main goal of medical examination of patients with tuberculosis is the timely detection of the first, clearly expressed symptoms for timely therapy. As soon as the disease is cured, the person is removed from the register. If the course of the disease is complicated, and the resulting changes are irreversible, it is necessary to be registered throughout life.
Having registered, a person is assigned a certain group, which allows you to achieve the following goals:
- prescribe the most effective treatment based on the schedule of consultations and examination results;
- determine a comfortable period of rehabilitation for a recovered person.
The dispensary registration group for tuberculosis is determined taking into account the form of the disease and the severity of its course. It is in accordance with such data that the doctor will be able to determine the most effective approach to treating the patient, thereby facilitating the course of the disease.
Groups
The division of patients into certain groups contributes to their timely deregistration. So, we can distinguish 7 groups:
0 group. This group of dispensary observation is assigned to people with unspecified disease activity. There is group 0A and group 0B. In the first case, there is a need to clarify the activity of tuberculosis, and in the second case, additional examinations are required to confirm the diagnosis.
1 group. This includes people who suffer from an active form of the disease. This group is also divided into several types:
- I-A: TB diagnosis for the first time;
- I-B: exacerbation of an already identified process in the lungs;
- I-B: treatment interruption in the past.
Group 2: This group for accounting for the tuberculous process is assigned to people who have a subsiding active course of the disease. Group II-A includes persons who are subject to clinical cure with intensive treatment, and group II-B includes those who suffer from an advanced form of the pathology, but require anti-relapse and restorative treatment.
3rd group. The third group can include patients who have already been cured of such a lung disease.
4 group. This group is assigned to persons who are in contact with patients with an open form of the disease.
5 group. This includes persons who have an extrapulmonary tuberculosis process or who have already been cured of one.
6 group. Assigned to children and adolescents who have an increased risk of disease as a result of the administration of the drug.
7 group. This group is assigned to persons in whom tuberculosis has already been cured, but there is an increased risk of relapse.
According to tradition, in order to identify signs of the development of such a lung disease, a regular medical examination is carried out until the child reaches the age of majority, which involves diagnosing an organ using X-ray equipment.
In most cases, children become infected with this infection from sick adults with whom they have contact. In this case, the child is registered in the TB dispensary and assigned to a certain group (usually 4 or 6).
How often are tests for tuberculosis taken?
Carrying out diagnostic measures is mandatory for those persons who have frequent contact with infected people. As a rule, these are relatives with whom the child lives. Systematic diagnosis of tuberculosis is also necessary for people who have developed the human immunodeficiency virus (HIV) or any malignant process in the body.
Such individuals have an increased risk of developing both pulmonary tuberculosis and any other disease of an infectious nature. A blood test is also done for those people who have recently been released from places of detention, people without a fixed place of residence, taking drugs or abusing alcohol.
It is mandatory to carry out diagnostic measures for newborn children who were born from a sick mother. The most effective preventive method in this case is the timely vaccination of the child, which allows you to protect him from the development of pathology in the next 10 years. In subsequent years, he is given control injections of Mantoux to identify or refute the pathological reaction.
Upon reaching adolescence, the child can already do a fluorographic study, which will reveal a lung disease. But, nevertheless, such a diagnostic method will not give a 100% guarantee for the reliability of the development of tuberculosis. As additional studies, a blood test and an X-ray examination are prescribed.
As noted above, people who abuse drugs have a high chance of developing lung disease. If one of them has an active form of tuberculosis, therapy is mandatory. With a latent course of pathology, the need for treatment is determined by the doctor.
If there is a high risk of the transition of the disease from a latent course to an active one, specific treatment is required; in its absence, only medical supervision is sufficient. The risk zone includes people with the immunodeficiency virus (HIV). For them, therapy should begin as early as possible, immediately after the first signs of the disease are detected. Otherwise, the transition of the disease into an active course cannot be avoided.
Treatment of the disease
Immediately after the patient is registered, appropriate treatment begins, which should be comprehensive. The main principles of treatment of the disease in adults and children can be called:
- Compliance with the hygienic regime, namely, the diet, work and rest.
- Etiotropic treatment, which ensures the destruction of pathogens - mycobacteria. As a rule, antibiotics and synthetic chemotherapy drugs are prescribed for this purpose.
- Symptomatic treatment aimed at eliminating and reducing the intensity of the symptoms of the disease. For example, taking antipyretics is necessary to reduce fever, sleeping pills - to normalize sleep, etc.
- Surgical intervention, which is prescribed in advanced cases and with the ineffectiveness of conservative treatment.
- As an additional method of treating tuberculosis, physiotherapy is used.
To judge how effective the treatment of a disease is in a particular case, one can use the following criteria:
- Whether or not the isolation of bacteria has been stopped, which can be determined by microscopic examination (according to many foreign doctors, only this criterion can already confirm or refute the cure of the disease; other diagnostic measures are not necessary).
- Disappeared or not the symptoms of the inflammatory process.
- Whether there is a disappearance of active lesions on the lung, which can be seen on the radiograph.
- Can a person do the usual things that he could do before the development of tuberculosis.
If conservative treatment does not bring the desired recovery, surgical intervention is prescribed, which is also necessary in the following cases:
- if mycobacteria are resistant to chemotherapy drugs;
- if the occurrence of irreversible morphological changes is observed in the lungs;
- if there are negative consequences of the disease that can cause death (this includes pulmonary bleeding, suppuration, formation of stones, hemoptysis, etc.).
To avoid surgery and the occurrence of life-threatening consequences, it is important to consult a specialist at the first symptoms of tuberculosis.
Persons with suspected tuberculosis who, after undergoing a standard
diagnostic algorithm in PHC network organizations to remove or confirm
it does not seem possible to cause the activity of the process in the lungs or other organs
possible. These can be newly diagnosed and repeated cases with doubt
active and not registered in the dispensary in the TVET;
Children who need to clarify the nature of tuberculin sensitivity
ty and in differential diagnostics, not registered in the dispensary
in TB facilities.
Group 0 persons are prohibited from using anti-tuberculosis drugs.Observation period - 4 months
After the established period of observation and the absence of signs of active TB, the patient is removed from the dispensary. When active tuberculosis is established, the patient is transferred to group I. Children with an established post-infectious allergy to tuberculin are transferred to group III.
The first group (I) - persons with active forms of tuberculosis any localization with tank-
therioexcretion and without it.
Subgroups:
I A group - new cases of tuberculosis
Group I B - repeated cases of TB (transferred from group I A with the outcome of "treatment failure" and patients registered for repeated treatment) Group I - cases of drug-resistant tuberculosis receiving
Treatment with anti-tuberculosis drugs of the main or reserve rad (transferred from I A and I B groups) I D group:
Cases of drug-resistant tuberculosis with bacterial excretion
after a repeated course of treatment with PTP of the main or reserve glad, which
eye treatment in standard regimens is not possible (category
ria IV)
Patients with ineffective treatment with second-line drugs
Patients with ineffective treatment with first-line drugs, but prescribed
second-line drugs are contraindicated for them.
Patients with absolute intolerance to anti-TB drugs.
Patients with severe cases of decompensation of the functions of internal organs.
Patients of IA, 1B and IB groups are prescribed standard chemotherapy regimens according to treatment categories. Surgical treatment is carried out according to indications. Observation period determined by the duration of the full course of treatment. With the outcomes of treatment "cured" or "treatment completed", patients should be transferred to the II group of dispensary registration.
At the outcome of treatment "Violation of the regimen", the issue of continuing treatment with CVCC is decided individually.
Patients of group I G are not treated with anti-tuberculosis drugs. According to the indications, symptomatic (pathogenetic) therapy is carried out, including collapse therapy and surgical methods of treatment.
The activity of a doctor in a polyclinic is a combination of medical and preventive work. This also includes health education, vaccination, as well as clinical examination. What the latter includes, which groups of patients are distinguished during it (general and dispensary registration groups for tuberculosis patients), we will analyze further.
What is dispensary?
The dispensary method of work of a specialist, clinical examination is a dynamic active monitoring of the state of health of patients. The method is aimed primarily at improving health, increasing the working capacity of citizens, ensuring proper physical development in children and preventing and preventing diseases. The latter is achieved by a whole range of therapeutic, preventive and health-improving actions.
Who is included in the dispensary registration groups? And healthy people, and suffering from certain diseases, pathologies. How many dispensary registration groups are in this category? Accordingly, two - sick and healthy. Let's analyze them separately.
group "healthy"
- Observables whose state of health, due to certain physiological characteristics, requires systematic monitoring by a specialist. As a rule, these are minors (children and adolescents), expectant mothers.
- Persons who are systematically exposed to harmful factors at work, production.
- The so-called decreed contingent. This includes those employed in the food industry, employees of passenger and public transport, personnel of children's organizations, medical, public, preventive institutions, and so on.
- Special contingent. For example, victims of an accident at a nuclear power plant.
- Participants, invalids of the Great Patriotic War and persons equated to them.
This contingent is as follows:
- Identification of diseases and pathologies at an early stage.
- Preservation of health, ability to work (if relevant) of a citizen.
- Prevention of the development of diseases through timely treatment, prevention.
The sick group
This dispensary registration group will include the following citizens:
- Convalescents after a number of acute diseases.
- Suffering from chronic diseases.
- Persons with genetic, congenital diseases, certain malformations.
The goals of medical examination of these citizens are as follows:
- Early detection of pathologies and timely elimination of the causes that can lead to their progression.
- Prevention of exacerbations, complications, relapses of the disease.
- Preservation of full longevity, return of working capacity.
- Providing comprehensive qualified medical care as a way to reduce the threshold of morbidity, disability, and mortality.
- Carrying out rehabilitation, health-improving activities.
The main tasks of medical examination
Let's move on from dispensary registration groups to the event itself. Its main tasks are:
- Identification of risk groups for the development of a particular disease. This is achieved through preventive medical examinations, which we will discuss further.
- Active monitoring of the risk group, improvement of these individuals.
- Dynamic monitoring of dispensary registration groups.
- Examination, treatment, rehabilitation according to the negotiability of the patients themselves.
- Creation of automated systems, databases that help to keep a full account of groups.
Medical preventive examinations
These activities are aimed at the following:
- Accounting, examination of patients, selection of a contingent for certain groups of dispensary registration.
- Conducting a population census at the site by a health worker.
- An examination to assess the state of well-being, the health of a citizen, to determine the risk of developing a dangerous disease, pathology.
Types of medical examinations
Preventive medical examinations in our country are found in three varieties:
- Preliminary. They are passed by persons before the start of studies, work. The goal is to determine the professional suitability of a citizen for a particular job, to identify contraindications for this activity.
- Periodic. They are already being carried out in a systematic, planned manner. In particular, such a medical examination is mandatory for those working at enterprises with hazardous and harmful working conditions, pregnant women, children and adolescents, schoolchildren, students of secondary and higher educational institutions, persons exposed to radioactive irradiation, participants, disabled people of the Great Patriotic War and equated to them in terms of the law of the citizens.
- Target. The main task is early, timely detection of a dangerous pathology. They are carried out in tuberculosis dispensaries, oncology centers, etc.
The main forms of medical examinations
Two categories can be distinguished here:
- Individual. Relevant when a citizen applies to a medical institution for issuing a sanatorium card, for a certificate, in connection with some kind of disease. It is also a call of certain persons by a doctor to a clinic for a medical examination, an examination of those undergoing treatment in a hospital, having contact with infectious patients, and so on.
- Bulk. As a rule, they will be held among organized groups of people - school classes of children and adolescents, student groups, young men of pre-conscription age, workers and employees of certain enterprises, organizations and institutions. They are complex in nature, they can combine targeted and periodic medical examinations at once.
Population health groups
Based on the results of the medical preventive examination, one of three observation groups is determined for a citizen:
- D1 - healthy citizens. These are persons who neither during the examination nor in the anamnesis (medical history) found serious diseases. Citizens who do not have complaints about their state of health.
- D2 - practically healthy. Who belongs here? Persons who have a history of chronic diseases that are not accompanied by exacerbations for several years. Having a borderline condition, classified as a risk group for any disease, pathology. Also, those who have had an acute infection or who are ill often and for a long time.
- D3 - chronic patients. Additionally, three categories of citizens are distinguished. The first one is with a decompensated course of diseases, with stable pathological dysfunctions, which lead to disability, irreversible loss of working capacity. The second - with subcompensated development of the disease, frequent periodic exacerbations, prolonged loss of working capacity. The third - with a compensated course of the disease, infrequent exacerbations, a short disability.
Groups of dispensary registration of patients with tuberculosis
There will be a different gradation from the general one. The following groups are distinguished in the tuberculosis dispensary:
- Zero. Diagnostic for children. For adults with tuberculosis of doubtful activity.
- First. First diagnosed disease. Tuberculosis relapse.
- Second. Chronic forms, chronic progression of the process.
- Third. Those persons who have been clinically cured of tuberculosis.
- Fourth. Persons permanently residing with bacterial excretion.
- Fifth. Patients who have
- Sixth. Children not vaccinated with BCG infected with MBT. Children who have complications after vaccination.
- Seventh. Patients with sarcoidosis.
We will analyze each of the groups in more detail.
Zero group
- Children who need to clarify the nature of sensitivity to tuberculin, determine the activity of tuberculous changes, the etiology of intoxication, damage to vital systems.
- Adults with tuberculous changes in doubtful mild stage.
First group
Divided into additional subcategories:
- 1A - dispensary registration group. Tuberculous intoxication in children, newly diagnosed tuberculosis in adults.
- 1B - group of patients with recurrent tuberculosis.
- 1B - a group of patients with newly diagnosed but ineffectively cured tuberculosis
Second group
- 2A - a group of patients transferred from the 1st group due to the impossibility of a complete cure for the disease within 2 years. At the same time, they did not reveal severe changes characteristic of a chronic disease.
- 2B group of patients transferred from the 1st category due to treatment failure. This group has already developed severe chronic changes in the respiratory system.
Third group
And again, doctors will distinguish two additional categories of patients:
- 3A - dispensary registration group. These are individuals who have been diagnosed with large residual changes, as well as small ones, but with a number of aggravating factors.
- 3B - a group of patients with minor changes that are not accompanied by any aggravating factors.
Fourth group
Here are the following categories of persons:
- Contacting with a bacterioexcretor, an animal with tuberculosis.
- Contact with a person or animal suffering from tuberculosis.
- Children and adolescents who have been in contact with a patient with active TB without isolating the bacteria.
Fifth group
Forms of extrapulmonary tuberculosis:
- Zero group. Disease of questionable activity.
- 5A - a group of patients with newly diagnosed disease, recurrence cured.
- 5B - a group of people with a chronic or progressive disease.
- 5B - a group of patients who have a history of clinically cured disease, leaving behind large or small changes.
Sixth group
Children and adolescents under observation fall into three categories:
- 6A is a group of patients with the so-called tuberculin test bend.
- 6B - group of patients with hyperergic reaction, progression of tuberculin sensitivity.
- 6B - a group of unvaccinated BCG at the scheduled time, having complications after vaccination.
Seventh group
- 7A is a group of patients with active sarcoidosis.
- 7B - a group of patients with a relapse of the disease.
- 7B - a group of patients with clinically cured disease.
Now you are familiar with the dispensary registration groups as part of preventive medical examinations. We also analyzed the gradation of patients registered in the dispensary for tuberculosis.
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13.2. Dispensary observation of adults
The contingents of adults subject to dispensary registration consist of four groups:
0 (zero) group - persons with unspecified activity of the tuberculosis process and in need of differential diagnosis to establish the diagnosis of tuberculosis of any localization;
0A subgroup - specification of the activity of the tuberculosis process. Observation for at least three months, a complex of diagnostic measures is carried out, according to indications, trial chemotherapy;
0B subgroup - differential diagnosis of tuberculosis and other diseases. The observation period is 2-3 weeks during a complex of diagnostic measures.
The examination of group 0 includes an X-ray, tomogram, ultrasound (for tuberculosis of the urogenital organs), bacterioscopy, sowing before enrolling in the group, in the future at least 1 time per month. The purpose of accounting is to establish a diagnosis.
group 1 - patients with active tuberculosis of any localization;
1A subgroup - patients with newly diagnosed disease. The observation period is not more than 24 months from the date of registration;
1B subgroup - with a recurrence of tuberculosis. The observation period is no more than 9 months.
Subgroup 1B - patients who interrupted treatment or were not examined at the end of the course of treatment (the result of their treatment is not known).
In both subgroups, patients with bacterial excretion and without bacterial excretion are distinguished.
The frequency of visiting the dispensary for outpatient treatment is at least 1 time in 10 days, after inpatient or sanatorium treatment - at least 1 time per month. The group undergoes a comprehensive basic course of treatment. Radiation examinations of patients with tuberculosis of the respiratory organs during the course of chemotherapy are carried out in the intensive phase at least 1 time in two months, studies on the office - at least 1 time per month, and also before the decision to move to the continuation phase, to the continuation phase according to indications at the end 2nd month of chemotherapy and further - according to indications. Radiation methods of examination and research on the MBT are repeated before the completion of the course of treatment. Upon completion of the course of chemotherapy, the examination is carried out at least 1 time in 6 months. Patients with extrapulmonary tuberculosis are examined according to indications, but at least once every 6 months. The purpose of observation in the group is to achieve a clinical cure and transfer to the III group of registration of 85% of patients after an effective basic course of treatment, but no later than 24 months from the date of registration. Transfer of patients to group II - no more than 10% of the number of group I.
Group II - patients with active forms of tuberculosis with a chronic course.
II A subgroup - patients in whom, as a result of intensive treatment, a clinical cure can be achieved. The duration of observation in the dispensary is not limited, individual complex chemotherapy is carried out, the visit to the dispensary is determined by the patient's condition and the treatment being carried out;
II B subgroup - patients with a far advanced process, whose cure cannot be achieved by any methods and who need general strengthening, symptomatic treatment and periodic (if indicated) anti-tuberculosis therapy.
Radiation examinations of patients with tuberculosis of the respiratory organs during a course of chemotherapy are carried out in the intensive phase at least 1 time in 2 months, studies on MBT - at least 1 time per month; before the decision to move to the continuation phase; in the continuation phase, according to indications, radiation methods and studies on the Office at the end of her 2nd month and in the future - according to indications. Radiation methods of examination and research on the MBT are repeated before the completion of the course of treatment. Upon completion of the course of chemotherapy, the examination is carried out at least 1 time in 6 months. Patients with extrapulmonary tuberculosis are examined according to indications, but at least once every 6 months. This includes patients transferred from group I. These patients need systematic monitoring and general health-improving and treatment-and-prophylactic measures, since a favorable course of the process is not yet a guarantee of a cure. The goal of observation in the PA group is to achieve a clinical cure of tuberculosis every year in 15% of patients after transfer to the subgroup. In the NB subgroup, the duration of observation is not limited, therapeutic measures are taken to prolong life, surgical and sanatorium treatment according to indications. A visit to the dispensary is determined by the treatment and the condition of the patient. Radiation methods of research and research on the office are carried out according to indications, but at least 1 time in 6 months. The purpose of accounting in the subgroup is to increase the life expectancy of patients, reduce the spread of tuberculosis infection.
Group III - persons cured of tuberculosis of any localization with large and small residual changes or without residual changes. The terms of observation in the dispensary of persons with large and small residual changes, in the presence of aggravating factors - 3 years; with small residual changes without aggravating factors - 2 years; without residual changes - 1 year. Comprehensive examination of patients
at least once every 6 months. Carrying out anti-relapse courses of chemotherapy according to indications, sanatorium and restorative treatment. X-ray methods of research are carried out, the study of sputum, urine and other diagnostic material before enrolling in the group, in the future at least 1 time in 6 months. With clinical well-being, deregistration and transfer under supervision to polyclinics of the general medical network, followed by medical examinations 2 times a year for 3 years after deregistration.
Group IV - persons in contact with sources of tuberculosis infection.
IV A subgroup - persons who are in household and industrial contact with the source of infection. The duration of observation is determined by the duration of the patient's cure plus one year after the termination of contact with the bacterioexcretor.
IV B subgroup - persons who have professional contact with sources of infection.
A comprehensive examination is carried out 2 times a year. In the first year after identifying the source of infection, a course of chemoprophylaxis is carried out for 3-6 months, according to indications, a repeated course of chemoprophylaxis is carried out, general strengthening measures that increase immunity, including sanatorium treatment, anti-epidemic measures in the outbreak. The duration of observation in the 1UB subgroup is determined by the period of work in conditions of professional contact plus one year after its termination. A comprehensive examination is carried out 2 times a year: the first time - an x-ray of the chest, blood and urine tests, for women additionally - an examination by a gynecologist; the second time - an examination by a dispensary doctor; laboratory, radiation, instrumental research methods according to indications. It is necessary to monitor compliance with safety regulations, an annual course of general strengthening treatment, chemoprophylaxis (according to indications). Apply radiation methods of research, analyzes of sputum, urine and other diagnostic material before enrolling in the group, then at least 1 time in 6 months. The overall incidence of contact persons in bacillary foci and persons from professional contact should not exceed 0.25% of the average annual number of the group.
Basic concepts used in the observation of patients with tuberculosis. An active tuberculous process is understood as a specific inflammatory process caused by Mycobacterium tuberculosis (MBT) and determined by a complex of clinical, laboratory and radiological signs.
The concept of tuberculosis of doubtful activity refers to changes in the lungs and other organs, the activity of which is unclear.
The chronic course of active forms of tuberculosis is a long, more than 2 years, course of the disease, in which clinical, radiological and bacteriological signs of the activity of the tuberculosis process persist.
Clinical cure is the disappearance of all signs of an active tuberculous process as a result of the main course of complex treatment.
An exacerbation is a manifestation of new signs of the activity of the tuberculous process after a period of improvement or an increase in the signs of the disease when observed in groups I and II before the diagnosis of "clinical cure" is made.
Relapse is understood as the appearance of signs of active tuberculosis in persons who have previously had tuberculosis and have been cured of it, observed in the third group or deregistered due to recovery.
Control questions
1. What is the tactics of observation of adult patients in group 0?
2. What contingent of patients belong to the II group of registration in adults?
3. List the criteria for registering adult patients in group I.
4. Which contingent belongs to the IV group of children and adolescents?
5. What activities are carried out in the II group of registration of children and adolescents?
For convenience, tuberculosis patients are divided into dispensary registration groups, or contingents. Each group has a specific list of mandatory activities.
1.
Adult patients to be registered in the PDD are divided into the following groups.
0 (zero) group - persons with respiratory tuberculosis of doubtful activity. X-ray examination is carried out when enrolling in a group, and then 1 time in 2 months. Bacterioscopy and culture are performed before enrollment, then once every 2-3 months.
- I-A subgroup - patients with newly diagnosed process, exacerbation or relapse. X-ray examination is carried out before enrollment in the group, 1 time in 2 months. until the bacterial excretion stops, the infiltration resolves and the cavity closes, after that 1 time in 3-4 months. before transfer to group II. Bacterioscopy and culture - at enrollment, 1 time per month in the presence of bacterial excretion, and then 1 time in 2-3 months.
- I-B subgroup - chronic tuberculous process lasting more than 2 years. X-ray examination - during therapeutic measures 1 time in 2 months, in remission - 1 time in 3-6 months. Bacterioscopy and culture during treatment - at least 1 time in 2-3 months, in remission - 1 time in 6 months.
Group II - patients with subsiding active tuberculosis of the respiratory system; X-ray examination - 1 time in 3 months, bacterioscopy and culture - at least 1 time in 3 months.
Group III - persons with clinically cured respiratory tuberculosis. X-ray examination - 1 time in 6 months, bacterioscopy and culture - at least 1 time in 6 months.Group IV - persons who are in contact with bacterial excretors (including employees of anti-tuberculosis institutions) or farm animals with tuberculosis. Fluorography - at least 1 time in 6 months. Detection of any changes in radiography in persons who have been in contact with a bacterioexcretor is an indication for computed tomography (CG) of the chest organs. Bacterioscopy and culture - if pulmonary tuberculosis is suspected.
Group V - patients with extrapulmonary tuberculosis and persons cured of it. X-ray and bacteriological examinations are carried out as in group IV.
Group VII - persons with residual changes after cured (including spontaneously) tuberculosis of the respiratory organs, with an increased risk of its reactivation. X-ray and bacteriological examinations are carried out before enrollment in the group, and then at least once a year.2. In the dispensary observation of children and adolescents, there is also group VI, it includes children and adolescents with an increased risk of tuberculosis, selected for observation based on the results of tuberculin diagnosis.
There are also features of observation in other groups.
It is important for a general practitioner to know that patients with active pulmonary tuberculosis are observed in groups I and II, and extrapulmonary - in groups V-A and V-B. Persons of the I group of dispensary registration with the indication of CD (+) in the diagnosis pose an epidemiological danger to others.
Active tuberculosis is a process in which M. tuberculosis is bacteriologically detected in patients or typical changes (granulomas) for tuberculosis are detected histologically, as well as clinical and radiological signs characteristic of tuberculosis.
The classification of tuberculosis in the Russian Federation distinguishes the following forms of this disease.
- Tuberculosis intoxication in children and adolescents
- Primary tuberculosis complex
- Tuberculosis of the intrathoracic lymph nodes
- Disseminated tuberculosis
- Miliary tuberculosis
- Focal pulmonary tuberculosis
- Infiltrative pulmonary tuberculosis
- Caseous pneumonia
- Tuberculoma of the lungs
- Cavernous pulmonary tuberculosis
- Fibrous-cavernous pulmonary tuberculosis
- Cirrhotic tuberculosis of the lungs
- Tuberculous pleurisy (including empyema)
- Tuberculosis of the bronchi, trachea, upper respiratory tract, etc. (nose, mouth, pharynx)
- Tuberculosis of the respiratory organs, combined with dusty occupational lung diseases
- Tuberculosis of the meninges and central nervous system
- Tuberculosis of the intestines, peritoneum and mesenteric lymph nodes
- Tuberculosis of bones and joints
- Tuberculosis of the urinary and genital organs
- Tuberculosis of the skin and subcutaneous tissue
- Tuberculosis of peripheral lymph nodes
- Tuberculosis of the eye
- Tuberculosis of other organs
In Russia, the transition to the International Classification of Diseases (ICD) of the 10th revision is currently underway. The tuberculosis section in the ICD-10 is as follows.
A15 Tuberculosis of the respiratory organs, confirmed bacteriologically and histologically
A15.0 Pulmonary tuberculosis, bacterioscopically confirmed with or without culture growth
A15.1 Pulmonary tuberculosis, confirmed by culture alone
A15.2 Pulmonary tuberculosis, histologically confirmed
A15.3 Pulmonary tuberculosis, confirmed by unspecified methods
A15.4 Tuberculosis of intrathoracic lymph nodes, confirmed bacteriologically and histologically Excluded if specified as primary
A15.5 Tuberculosis of the larynx, trachea and bronchi, confirmed bacteriologically and histologically
A15.6 Tuberculous pleurisy confirmed bacteriologically and histologically
A15.7 Primary tuberculosis of the respiratory system, confirmed bacteriologically and histologically
A15.8 Tuberculosis of other respiratory organs, confirmed bacteriologically and histologically
A15.9 Tuberculosis of the respiratory system, unspecified, bacteriologically and histologically confirmed
A16 Tuberculosis of the respiratory system, not confirmed bacteriologically or histologically
A16.0 Pulmonary tuberculosis with negative results of bacteriological and histological examinations
A16.1 Pulmonary tuberculosis without bacteriological and histological examinations
A16.2 Pulmonary tuberculosis without mention of bacteriological or histological confirmation
A16.3 Tuberculosis of intrathoracic lymph nodes without mention of bacteriological or histological confirmation Excludes tuberculosis of intrathoracic lymph nodes specified as primary
A16.4 Tuberculosis of the larynx, trachea and bronchi without mention of bacteriological or histological confirmation
A16.5 Tuberculous pleurisy without mention of bacteriological or histological confirmation Excluded tuberculous pleurisy in primary respiratory tuberculosis
A16.7 Primary respiratory tuberculosis without mention of bacteriological or histological confirmation
A16.8 Tuberculosis of other respiratory organs without mention of bacteriological or histological confirmation
A16.9 Tuberculosis of the respiratory system, site unspecified, without mention of bacteriological or histological confirmation
A17+ Tuberculosis of the nervous system
A17.0+ Tuberculous meningitis (G01*)
A17.1+ Meningeal tuberculoma (G07*)
A17.8+ Tuberculosis of the nervous system of other sites
A17.9+ Tuberculosis of nervous system, unspecified (G99.8*)
A18 Tuberculosis of other organs
A18.0+ Tuberculosis of bones and joints
A18.1+ Tuberculosis of the genitourinary organs
A18.2 Tuberculous peripheral lymphadenopathy Excludes: tuberculosis of lymph nodes: mesenteric and retroperitoneal (A18.3); intrathoracic (A15.4, A16.3); tuberculous tracheobronchial adenopathy (A 15.4, A 16.3)
A18.3 Tuberculosis of intestines, peritoneum and mesenteric lymph nodes
A18.4 Tuberculosis of the skin and subcutaneous tissue
A18.5+ Tuberculosis of the eye Excluded eyelid lupus vulgaris (A18.4)
A18.6+ Tuberculosis of the ear Excluded tuberculous mastoiditis (A18.0+) A18.7+ Tuberculosis of the adrenal glands (E35.1*)
A18.8+ Tuberculosis of other specified organs
A19 Miliary tuberculosis. Includes: generalized tuberculosis; disseminated tuberculous polyserositis
A19.0 Acute miliary tuberculosis of one specified localization
A19.1 Acute miliary tuberculosis of multiple sites
A19.2 Acute miliary tuberculosis, unspecified
A19.8 Other forms of miliary tuberculosis
A19.9 Miliary tuberculosis, unspecified
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