Tuberkulose

ICD-10 - Code Tuberkulose
A15-A19 Tuberkulose

the Tuberkulose (briefly TBC or Tbc, in former times also the shrinking craze or the disease cook, colloquially „the moths “) is an infection. The TBC states the statistics of the deadly infectionsand the WHO estimates that in the next ten years 30 million deaths will occur. In Germany as well as in many other countries the Tuberkulose is subject to the obligation to register.

The exciters of the Tuberkulose are bacteria of the Mycobacterium tuberculosis complex with thatnamed-giving and most important kind Mycobacterium tuberculosis. Only about 5 10% with Mycobacterium tuberculosis infected gotten sick at Tuberkulose, concerned are particularly humans with weakened immune system. The transmission effected usually via droplet infection from humans gotten sick in thatEnvironment. If germs are provable in the ejection (Sputum), one speaks of „openly “TBC. From coughs then an infectious aerosol results, whereby the exciters remain for hours in the room air. Since cattle can likewise get sick to the Tuberkulose, was in former times nonpasteurisierte milk a common source of infection. Because of the transferability of animals on humans the TBC ranks among the zoo eyes.

For instance a third of the population of world is infected with TBC and each second is added a further case. About eight millionHumans get sick and to about two million die at the illness per year, frequently due to insufficient possibilities of treatment, since the therapy is expensive antibiotics required and lengthy: It often cannot be accomplished with the social/social life circumstances of the concerning.

Also are inmany regions concerned the laboratories necessary for the diagnosis and treatment missing. Particularly in Eastern Europe a causing concern increase of the Tbc is to be registered , above all also with multi-resistant exciter trunks by poverty and the fall of the health service. Such medicine-resistant Tuberkulosestämme is an also world-wide always frequent cause of the illness.

An Tbc infection is particularly problematic with HEAVES - infected with manifest AIDS: The probability of the outbreak of an TB-illness increases by a multiple, if an HIV infection is present. However through HEAVES weakened leadsImmune system with a TBC routine investigation often to negative results, although the illness is present (see also error 1. and 2. Kind). With this skin tests (Tuberkulin test, Tine test) the immunological reaction is examined for exciter components, which is restrained by AIDS.The process of the TBC is then substantially accelerated. In poor countries TBC is considered as indication of the outbreak of AIDS and leads with the majority all HIV getting sick to death. The WHO demands and promotes therefore a world-wide co-ordination of the TBC and AIDS - Research.

TBC is one oldest troubles of mankind and also an indicator for the living conditions in a society, since she can be back-pushed toward a good nutrition and sufficient hygenic conditions also without special medical measures.

Table of contents

exciters of the Tuberkulose

Die säurefesten Stäbchen in Ziehl-Neelsen-Färbung sind mit einem Pfeil markiert.
the acid-resistant Stäbchen in Ziehl Neelsen colouring is with oneArrow marks.
The most important exciter of the Tuberkulose, Mycobacterium tuberculosis, is a grampositives, aerobes stäbchen bacterium, which divides all 16 to 20 hours. Compared to other bacteria, which have division rates within the range of minutes, this is extremeslowly.

Mycobacterium tuberculosis is able to resist weak disinfectants. The microscopic proof succeeds by the typical coloring characteristics: The bacterium keeps its colouring after treatment with a sour solution and therefore as „acid-resistant Stäbchen “is designated. In the most commonThe Ziehl Neelsen colouring, the red dyed germs before a blue background stand out colouring of this kind. The proof succeeds further by Fluoreszenzmikroskopie and by the auramine Rhodamin colouring. In the gram's stain Mykobakterien hardly present themselves, the structure of cell wall resemble howeverstrongly grampositiver bacteria, so that Mycobacterium is formally classified tuberculosis as grampositiv.

To the same bacteria's group belongs further Mykobakterien, which partly the Tuberkulose very similar clinical complaints can cause: M. bovis, M. africanum, M. kansasii, M. microti and M. avium. The first two exciters are rare, third and fourth usually cause no human infection. Mycobacterium tuberculosis, M. bovis, M. africanum, M. microti, M. canetti, M. pinnipedi, M. caprae and the inoculation trunk M. bovis BCG in summary as Mycobacterium tuberculosis complex.

history

Tuberkulose is well-known since the antiquity. Skeleton remnants of prähistorischen humans (4000 v. Chr.) showed traces of the illness. Tuberkulöse destruction becamealso in bones of Egyptian mummies of 3000-2400 v. Chr. found. There were referring to Tuberkulose in India and America around 2000 v. Chr.

Around 460 v. Chr. Hippokrates Phthisis marked (griech. φϑίσις = decrease) as the widen-common illness of allTimes, which was nearly always deadly.

Because of the multiplicity of their symptoms the illness into the 1820er was recognized years not as uniform illness and was not called only 1839 of Johann Lukas beautiful flax „Tuberkulose “.

The bacterium Mycobacterium tuberculosis became to 24. March 1882 by Robert cook described. It received the Nobelpreis in physiology ( medicine ) to 1905 for this discovery. Cook did not believe that the bovine and human Tuberkulose was similar, which retarded the recognition of infected milk as source of the illness.Later this source was eliminated by pasteurization. Cook designated 1890 an Glycerin excerpt of the Tuberkelbazillen as „aid “for the recognition of the Tuberkulose and called him Tuberkulin. It was not effective, but by Pirquet for a test of the latent Tuberkulose was later adapted.

First genuine success with Immunisierung against Tuberkulose became of Albert Calmette and Camille Guerin 1906 with their BCG - vaccine reaches. It became first to 18. July 1921 in France at humans applied. Nationalisti currents prevented the widespread use toafter the Second World War.

Tuberkulose caused in 19. and early 20. Century general interest as the endemic illness urban arms. 1815 were caused in England of one of four deaths and 1918 a Sechstel of the deaths in France by Tuberkulose.The first Tuberkulose sanatorium was opened 1859 in Poland; later 1885 in the United States. After the recognition of the illness as sticking on the Tuberkulose in 1880ern became a compulsorily notifiable illness in Great Britain. It gave the campaigns up for the avoidance of the Ausspuckenspublic places and stuck on arms became lively „“to go into sanatoriums which resembled rather prisons. Despite the maintained use to the fresh air and the work in the sanatorium 75% of the passengers deceased within five years (1908).

In Europe those causedTuberkulose 1850 500 of 100.000 and 1950 50 of 100.000 deaths. Improvements in the public health service already reduced number of the illnesses before introduction of antibiotics.

1946 with the development of the antibiotic Streptomycin became apart from prevention the active treatment possible. Before itonly the surgical treatment was well-known, in particular the Pneumothorax - technology. To arrange a lung concerned artificially collapsed around the lung to the stop and to healing the changes completely. This technology was however from little use and became after 1946gradually adjusted.

Hopes that the illness could be completely eliminated, were destroyed since the occurrence of antibiotic-resistant trunks in the eighties. Thus it gave around 1955 50,000 Tuberkulose cases in Great Britain. 1987 was it 5,500, but inYears 2001 again over 7.000 confirmed cases. Because of the task of the public health service in New York in the seventies there was a rereviving in the eighties. The number of those, which could not take their medicines, was high. New one York had with more than 20,000 „not necessary “Tuberkulose patients with antibiotic-resistant trunks (D. h., resistant to at least Rifampin and Isoniazid) finished become. The rereviving of the Tuberkulose resulted 1993 in an explanation to the global health emergency by the World Health Organization. A furtherReason for the renewed increase of the Tuberkulose cases in the western world is the rising number at humans with migration background from countries with high Prävalenz.

By restraining a set of genes, researchers caused themselves 2003 inadvertently a more dangerous and fasterreproducing trunk of the Tuberkulosebakteriums.

The WHO has the 24. March in the year 1996 to the Welttuberkulosetag explains.

epidemiology (spreading and frequency)

in Germany in the year approximately 7,000 Tuberkulosekranke are announced, what in approximately also the material numbers to correspondmight. The dark number is not high with this serious illness. About 400 to 500 patients dies annually at the illness. Both the number of the announced cases and those the Tuberkulose dead ones are declining for some years (conditions 2005). Becomes world-widethe number of the deaths per year on 2 million humans estimated, those of the new infections on eight to nine million.

In Germany the illness is particularly common in Hamburg , Bremen and Berlin. About 10 illnesses come on 100.000 inhabitants.Groups of main concerning are homeless people as well as alcohol and drug-dependent.

Tuberkulose is in Africa apart from AIDS the most frequent cause of death. Both diseases arise particularly with the inhabitants of Metropolenslums in close interrelation (immune weakness) to each other.

statistic numbers

  • inThird of the population of world is considered as TBC infects
  • 5-10 per cent of the infected ones in the process of its life an active TB will develop
  • two million humans to die annually world-wide at Tuberkulose
  • 1998 gave it to roughly eight million new infections, of it 3.5 million sticking on TB
  • iftreatment effected, 50-60% of the TB-patients do not die within the next 2 to 5 years
  • eight million humans develop Tuberkulose each year, of it die 2-3 million 98%
  • of the new TBC cases annually step in poorer countries on
  • 99% of the TBC conditioned deaths stepin poorer countries on
  • most of HIV positive humans die at TBC
  • 75 per cent of the deaths concern the age group between 15-45 years

(sources: IUATLD/Internationale Tuberkulosegesellschaft, WHO, physicians without borders)

of transmission paths of the TBC

  • by inhalation
    • infectious droplet particles,
    • of dust particles,
    • dried up eliminations,
  • by the meal
    • feed Tbc, for example by milk,
  • over the skin, the so-called Inokulations - Tbc,
  • fetal by erregerhaltiges fruit water,
  • diaplazentar hämatogen (= by mütterliches blood via the Plazenta to the child).
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Symptoms

Primärtuberkulose, closed Tuberkulose, early form

after the infection over infected droplets form the bacteria in the following three to six weeks concerned knötchenförmige inflammations small in the lung of the person. Frequently this inflammation procedure does not cause complaints. Can doin addition, symptoms arise as for example

the herd of inflammation by blood defense cells are particularly included. Small Knötchen (“Tuberkel” forms). Soisolated no complaints cause the Tuberkulose herd, can however for many years in the body survive.

Reaktivierungstuberkulose, open Tuberkulose, late form

only with five to ten per cent of humans, who were infected with Tuberkulose, breaks the illness off at a later time again. ThosePatients complain then about different symptoms:

  • The cough continues longer than three weeks.
  • When coughing pain in the chest and difficulty in breathing.
  • Cough up from yellowish-green Schleim.
  • Bloody ejection (strong lung damage).

The Tuberkulose bacteria increase in the lung and destroy thatFabric. The destroyed fabric one expenditure-coughs and contains the bacteria - the patient suffers now to open Tuberkulose. In the advanced stage further organs can be struck. Then painful swelling step at knees - and other joints or the spinal columnup. A special form of the Tuberkulose is the Hauttuberkulose. Small wounds, tears and wart-like herd of pus, mainly at the hands, are and. A. typical symptoms of the Hauttuberkulose.

organs, those by the TBC to be affected know

diagnostics

the diagnosis of the Tuberkulose is not completely simple.Skin testing (Tuberkulin tests) are only reduced reliable. A bakteriologischer proof is safest in the ejection (Bronchialsekret) or in the gastric juice. In more recent time also the PCR test of investigation material worked. These research methods point however only an openTuberkulose after, i.e., the illness found connection to the Bronchialsystem and becomes recognizable the exciters in the ejection.

The x-ray examination or the CT of the lung , which shows the characteristic, moth-eat-like picture of the lung infestation of the Tuberkulose often, is well useful,which brought in the surname for the illness „the moths “. Also with closed Tuberkulose show these investigations findings. Unfavorable it is however that on a radiograph between a Tuberkulose and other lung illnesses cannot be differentiated always sufficiently surely.

Problematicare also findings with old, isolated and vernarbter Tuberkulose in the lung. Here it is often difficult to recognize a reactivation and to distinguish it for example from an other inflammatory lung illness.

A fast and safe diagnostics of the Tuberkulose is in particular because ofthe substantial epidemic-hygenic meaning of the illness and the aufwändigen investigations of contact people of a patient of importance.

standard therapy

different

antibiotics, also Antituberkulotika are to therapy [work on] mentioned, at the disposal:

  • Isoniazid
  • Rifampicin
  • Ethambutol
  • Streptomycin
  • Pyrazinamid
  • Thiacetazon, a sixth substance, is used only in the poorer countries, it not recommended for the treatment from simultaneous on HEAVE gotten sick patients. However the majority of the Tuberkulosekranken is at the same time HIV positive in some poor countries.

ForGermany is recommended as calculated standard therapy the income of a four-fold combination of Isoniazid, Rifampicin, Pyrazinamid and Ethambutol over two months and afterwards a two-combination of Isoniazid and Rifampicin for at least four further months.

Should itself in that only six to eightWeeks after beginning of therapy judgable micro-biological bacterial culture a resistance find, can be changed in the sense of a specific therapy on other antibiotics, to which the concrete bacteria trunk is actually sensitive (see also for this the anti-bio gram).

Isoniazid, Rifampicin and Pyrazinamid can tooLiver damage leads, Ethambutol to eye nerve damage and Streptomycin damages kidney and hearing. These organs should be supervised before beginning and in the process of the therapy.

Since the patients feel often relatively healthy, many take the tablets on their part after more certainlyTime no longer regularly (Compliance (medicine) compares).

therapy of the multi-resistant Tuberkulose

to be used combinations of different active substances:

  • The amino glycosides: Kapreomycin, Kanamycin
  • the Fluorchinolone: Ofloxacin and Ciprofloxacin and Levofloxazin
  • the Thionamide: Ethionamid, Prothionamid

Bakteriostatisch effectively:

  • PAS (Paraaminosalicylsäure), Cycloserin

the treatment of a multi-resistant Tuberkulose means the income of several medicines at the same time during one period of at least 21 months. In the first three months the patients receive a mixture from five different medicines. Those are fundamentalChances on a successful treatment of a multi-resistant Tuberkulose smaller than with the treatment of an uncomplicated Tuberkulose, even if the patients receive the most efficient therapy. The use of Ofloxazin and Levofloxazin can be recognized hardly by comparatively high product prices in poorer countries.Both active substances stand under patent protection of the manufacturers. Kapreomycin is driven out by only one manufacturer (Eli Lilly), at a price, which limits the use enormously.

inoculation

a protective inoculation (BCG) against the TBC becomes today ofthe constant inoculation commission no longer recommended, since the effect could not be proven. In addition the Tuberkulin test is always positive with inoculated persons, so that the diagnosis (for instance with a contact with a person, who got sick with “openly” TBC) becomes more aufwändiger.

With the development of the vaccine it came 1930 to the Lübecker inoculation misfortune, with which many children were infected by a wrong handling of the “inoculation” with TBC. Paradoxically one knows today much from the observation of these children about the process thatIllness.

why isn't the TBC so simple to treat?

  • The exciter isolates itself in the body and arouses the appearance that the illness healed. It is however not completely eliminated, but can later again activelybecome.
  • The exciter is provable only by special colouring (Ziehl Neelsen). In the most frequently accomplished bacteria colouring after Gram it colors itself not on usually.
  • The exciter can develop resistances during an insufficient treatment against the assigned Antituberkulotika.
  • Oftenhumans are concerned, who are immune-weakened, since they suffer from a secondary illness or are addicted.
  • The most effective medicines against the multi-resistant Tuberkuloseformen are subject to the patent protection of the manufacturing Pharmaunternehmen, why the production of more economical Generika for the poorer countries is omitted.
  • ThoseTreatment must take several months for safe complete healing. Concerning often fast recovered feel and do not take their medicines any longer reliably (Compliance lacking). This is the background, before which z. B. in some large cities thatThe USA on public support instructed patients daily by Streetworkern to be visited, which carry the tablets and whose income locally control. With not income of the medicines the social welfare assistance is shortened or refused.

the TB in the art

Due to its enormous meaning the illness is reflected also again and again in the art. Some artists processed the confrontation with early (own) death in impressive way. Emotional deeply working pictures before our internal eye developed.

  • A DavoserTuberkulose sanatorium before the First World War. The sick-room with white-enamelled wash basin and metallic spitting cup. The model was the mountain yard from Thomas's man: Charm mountain (first edition of 1924). The world-well-known novel plays in Davos at a time without effective medicines. Hans Castorps(in the Geissendörfer - film Christoph squirrel) 7jährige „institute for detention “had a model, that by changes today like a material seventies-year box with Rustikalbalkons and the neon writing working „forest hotel Bellevue " shining far away was the mountain yard in the novel. “Your Tagespensum is only this: Eat,lie and eat! Eat, lie and eat!“„The Schatzalp “- visitor, another, today substantially more well-known Davoser Lokalität, is completely safe itself here the original to have found finite. That is skillful made, erfühlte deception, it never was it, itis not it, but approximately so the charm mountain could look today and tomorrow, if a lung mental hospital were copied for realms of the 1900er years from the book. This looking for for the original play place witnesses from the constant effect of the novel.
  • Inthe opera of Giuseppe Verdi (music) and Francesco Maria Piave (libretto) „La Traviata “(Italian: The Gestrauchelte or the derailed one) perishes Violetta Valery very realistically three document long at the “white plague “. At that time nearly a scandalto produce death so realistically, which we can regard today rather as süssliche Verkleisterung. Nearly each music number of the opera remained until today a hit. Together with the Kameliendame was and is the Traviata one the completely large Multimedia- Productions around love and death from the bloom time of capitalism (came nearly at the same time book, music, film on the market).
  • John le Carré describes in the year 2001 a playing conspiracy of a multi-company, that in the novel the eternal gardner for securitynew means against TBC first in the field test at located ones in Kenya, Africa tests, and the ethical borders redefines.

famous ones of cases mentioned by

fictitious shapes:

literature

  • Wiss. Magazine: The Pneumologe. The magazine offers certified advanced training under http://www.cme.springer.de . The Abstracts of this magazine is here for medicine on-line users over many classes accessible
publishers: N. Konietzko; R. Loddenkemper; J. Lorenz; D. Ukena; T. Welte; H. Worth
ISSN 1613-5636 (printed version)
ISSN 1613-6055 (electronic version)

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