GENERAL CHARACTERISTICS

Tuberculosis is primarily a chronic infection that most often affects the lungs. Tuberculosis of the larynx, intestines, kidneys, bones and joints, and skin is less common. With tuberculosis, changes in the affected organs, intoxication of the body are possible, metabolism and the functioning of various organs and systems, in particular the digestive organs, are disrupted.

The nutritional regimen is based on the nature and extent of damage to the organ, the general condition of the body, and complications from other organs. The caloric content of the diet depends on the characteristics of the course of the disease, body weight and concomitant diseases. For exacerbation of tuberculosis and bed rest, 2500–2600 kcal per day is sufficient. With semi-bed rest – 2700 kcal; when the exacerbation subsides – 3000–3400 kcal. For chronic pulmonary tuberculosis, especially in young people, a high-calorie diet of 3600 kcal is recommended. Eating more calories is not healthy. A rapid and large increase in body weight may not improve, but rather worsen the patient's condition.

OBJECTIVES OF THERAPEUTIC NUTRITION

The main objectives of therapeutic nutrition for pulmonary tuberculosis are:

1. Providing the body with adequate nutrition in conditions of protein breakdown, deterioration of fat and carbohydrate metabolism, and increased consumption of vitamins and minerals.

2. Increasing the body's resistance to infection and intoxication.

3. Promoting normalization of metabolism.

4. Promoting the restoration of tissues affected by tuberculosis infection.

To accomplish these tasks, it is necessary to introduce an increased amount of protein with food (at least 120–140 g), the consumption of which is increased in patients with tuberculosis. Easily digestible protein products (milk, fish, eggs, meat) are recommended. The amount of fat is recommended within the physiological norm (100–120 g). Fats should be easily digestible, rich in vitamin A (butter, cream, sour cream), about a third - in the form of vegetable fat.

The amount of carbohydrates is within the physiological norm (450–500 g). In cases where, with tuberculosis, there is a violation of carbohydrate metabolism, allergization of the body (allergic diathesis, bronchial asthma, chronic eczema), excess body weight, patients need to limit carbohydrate intake to 300–400 g, mainly due to easily digestible ones (sugar, honey, jam , syrup, etc.).

With an exacerbation of the tuberculosis process, an increased release of mineral salts (calcium, potassium, phosphorus, sodium chloride) may be observed, so foods rich in them are introduced (milk, cheese, cottage cheese, eggs, figs, dried apricots, raisins, meat and fish products, nuts, etc.) .d.).

In case of exudative pleurisy, transudate, tuberculous meningitis, with increased secretions into the bronchi, kidney damage leading to edema, a hyposodium diet is prescribed, i.e. food is prepared without adding table salt. This diet helps to increase diuresis, resorption of fluid accumulated in the cavities, and subsidence of the inflammatory process. The liquid is administered in an amount of 900-1000 ml. In case of large blood loss, repeated vomiting, diarrhea, excessive sweating, the amount of table salt is increased to 20 g.

Patients with tuberculosis develop vitamin deficiency (especially ascorbic acid, vitamins A and group B). Consuming a sufficient amount of ascorbic acid increases the bactericidal properties of blood serum, increases the formation of antibodies, and reduces intoxication. The need for vitamin C is especially high in patients with fibro-cavernous process, at high temperatures and tissue breakdown. In this case, a sufficient amount of vegetables and fruits is recommended, and it is also necessary to periodically take up to 300 mg of ascorbic acid per day.

Patients with tuberculosis of the lungs, larynx, intestines and skin also need an increased amount of vitamin A - about 5 mg. To meet the need for vitamin A, dairy products, fish oil, egg yolk, as well as foods containing carotene - carrots, tomatoes, apricots, red peppers, etc. are recommended.

Particular attention should be paid to providing patients with B vitamins. They are directly related to protein metabolism, the need for which is increased in this group of patients. It is necessary to include foods rich in B vitamins into the diet - fresh vegetables, meat, dishes made from bran, brewer's or baker's yeast.

Calorie intake – 2500–3600 kcal.

BASIC PRINCIPLES OF THERAPEUTIC NUTRITION

1. The diet should be varied, taking into account the development of the tuberculosis process and the general condition of the body.

2. Strict regimens and limited nutrition can be prescribed only for a short period of time (in case of complications and exacerbations of the disease).

3. At all stages of treatment, nutrition should be differentiated.

It is necessary to observe the basic principles of qualitative and quantitative construction of the diet, depending on the nature and stage of the tuberculosis process, the state of the digestive organs, the presence of complications and concomitant diseases.

There are several therapeutic nutrition options for people with tuberculosis.

SOME HEALTH FOOD OPTIONS

First food option.

It is prescribed to patients with reduced reactivity of the body, general hypotension, low-grade fever, and a sluggish course of the disease.

The chemical composition of this diet: proteins 140 g, fats 100 g, carbohydrates 400 g, limiting easily digestible ones.

Calorie content 2700–3000 kcal. Content of ascorbic acid up to 350 mg, vitamin B1 5 g.

Cooking is normal.

Second option.

It is prescribed to patients with increased nervous excitability, low body weight, elevated temperature - up to 30 degrees, without signs of increased tissue breakdown, during the period of attenuation of the process of tuberculosis of the lungs, bones and joints.

Chemical composition of the diet: proteins 110–120 g, fats up to 120 g, carbohydrates 500–550 g. Ascorbic acid content up to 300 mg.

Cooking is normal.

Meals are fractional - 5 times a day.

Third food option.

This option is prescribed during the period of exacerbation of the process with pronounced tissue breakdown, significant inflammatory phenomena occurring with high temperature and exhaustion. In these cases, there is usually increased protein breakdown.

Chemical composition of the diet: proteins 120–140 g, fats 100 g, carbohydrates 400–500 g.

Calorie content 3000–3500 kcal.

It is necessary to introduce an excess amount of ascorbic acid. The remaining vitamins are recommended within the physiological norm. Calcium up to 2 mg per day. Table salt 8 g. It is advisable to consume a large number of different drinks, raw juices, vegetables and fruits rich in mineral salts and vitamins.

During the period of exacerbation of the disease, appetite often decreases, disorders of the gastrointestinal tract often occur, which must be taken into account when composing the diet.

Culinary processing: all food is prepared pureed.

The diet is split, every 2–3 hours.

NUTRITION FOR PATIENTS WITH TUBERCULOSIS WITH ACCOMPANYING DISORDERS OF THE DIGESTIVE ORGANS

Patients with tuberculosis often have concomitant diseases of the digestive system. Chronic gastritis and colitis often occur in connection with taking anti-tuberculosis drugs. Gastritis is usually with low acidity. In this case, split meals are recommended with the obligatory exclusion of coarse plant fiber from the diet. Vegetables and fruits are given only in boiled and pureed forms; tough varieties of meat are also given in pureed or minced forms.

If the activity of the liver and biliary system is impaired, foods that cause irritation are excluded from the diet. Fatty meats and fish, fried foods, butter dough, smoked foods, canned food, marinades, strong tea and coffee are prohibited.

SAMPLE ONE-DAY MENU FOR TUBERCULOSIS

First option

First breakfast: curd pudding, buckwheat porridge with milk, tea.

Second breakfast: calcined cottage cheese, fruit mousse.

Lunch: broth with dumplings, fried steak with vegetables, apple compote without sugar.

Afternoon snack: soft-boiled egg (1 piece), rosehip decoction.

Dinner: boiled fish, baked with potatoes, carrot puree, tea with lemon without sugar.

Among the serious diseases that affect a large number of both adults and children is pulmonary tuberculosis. Every year, 9 million patients are diagnosed around the globe, and in 2 million, this disease leads to death. Tuberculosis is infectious, caused by several types of bacteria. Infection mainly occurs aerobically, in some cases through household contact. In patients, the lungs are affected; symptoms such as severe cough, shortness of breath, and expectoration of blood are clearly expressed. Weakness, increased fatigue, weight loss, and apathy also occur. There is a decrease in hemoglobin and weakened immunity. Treatment of the disease is a rather complicated process that can last for several months and even years. Along with drug therapy, special attention is paid to nutrition for tuberculosis, as one of the most important components of the process. Detailed information about tuberculosis is

The importance of nutrition in pulmonary tuberculosis

Main nutritional goals:

• The primary task for this pathology, both in children and adults, in addition to medications, is to provide patients with healthy foods, in conditions of increased metabolism of fats, carbohydrates and protein breakdown
• Increasing the body's defenses to enable the immune system to fight infection
• Normalization of metabolic processes to correct nutritional disorders caused by the disease
• Promoting the restoration of damaged tissues.

The choice of diet for tuberculosis is adjusted taking into account the nature of the disease, the patient’s condition, concomitant pathologies, and the patient’s age. In the case of the acute form, with bed rest, patients need to consume from 2200 to 2400 kcal. If the condition improves, their number can be increased to 2500. During the cessation of exacerbations, the number of calories should be from 2800 to 3100.

For patients with a chronic form, this especially applies to young people and children, the energy value of products should be increased by 10-15% above normal.

It is important to take into account that too high-calorie food during the treatment of pathology often leads to excess weight, this can negatively affect the patient’s condition and cause digestive problems.

Diet for tuberculosis

Meals must include:

• Squirrels
• Vitamins
• Carbohydrates.

The most valuable foods in terms of calorie content are fats. Their norm for patients should be 80-120 g per day. It is best to replenish the body with fats such as vegetable oil, butter, cream, and fish oil. It is better to avoid pork, beef and lamb fat.

The diet of patients with tuberculosis must include foods rich in protein, since their consumption during the disease is too high. Their daily norm is from 90 to 120 g, depending on the severity of the disease. Protein is necessary for the regeneration of diseased tissues and strengthening the body as a whole. Its sources are poultry, pork, beef, rabbit, all kinds of fish, eggs. If there are no contraindications, then you can include sausages, canned fish, and herring.

It is very important to include foods containing vitamins and beneficial microelements in the menu for tuberculosis. A large amount of them is found not only in vegetables and fruits; you can replenish the lack of vitamin A through fish oil, liver, and eggs. To increase vitamin B, when treating an illness, you should introduce bran, black bread, herbs, and dried fruits into the diet. When adults and children become ill, the need for vitamin C increases; it is found in lemons, cabbage, strawberries, bell peppers, etc. If necessary, they can be replaced with vitamin preparations.

In case of tuberculosis, it is necessary to include carbohydrate foods in the diet; they should not exceed 100-110 g per day; in the acute form, no more than 70 g. You can eat cereals, pasta, legumes, sugar, honey, and confectionery products. You should not eat cakes that are too fatty or have a lot of cream.

During treatment for tuberculosis, the need for dairy products also increases, especially in children. You can eat cheeses, milk, kefir, yoghurts, sour cream. You can replenish the lack of calcium with raisins, dried apricots and nuts.

Nutrition for children with tuberculosis

For a sick child, nutrition for this disease is an important part of treatment. Just like adults, children should be well fed during the course of their illness, paying attention not only to the quantity of food, but also to its quality. Excess food often causes obesity, and in certain cases can even lead to an exacerbation of the disease. It is recommended that a preschool child consume 2000 kcal per day, school-age children under 12 years old – 3000 kcal, and teenagers – 4000 kcal.

When treating a child’s illness, vitamins are included in his diet in large quantities, since a sick body needs them several times more than a healthy one. It is necessary to regularly eat meat products, eggs, fish, milk and dairy products, cereals, bread, etc. Sick children should take fish oil.

Nutrition for tuberculosis is an important aspect in the treatment of the disease, and if, with early detection of pathology, you adhere to the recommended diet, take prescribed medications, and follow all the doctor’s recommendations, you can get positive results in a short time.

Food occupies one of the main places in the life of every person, because with proper organization of the diet, it is a source of nutrients that provides the human body with an energetic life and strong immunity. With any serious illness, the body requires an increased amount of nutrients to overcome the disease. We will look at how to properly create a diet and organize nutrition for pulmonary tuberculosis so that the body receives the necessary strength to fight the disease.

Tuberculosis is a very dangerous infectious disease that can occur in both acute and chronic forms. In childhood, primary tuberculosis infection usually spreads through the lymphatic system.

And it is mainly the lymph nodes that are affected. In the adult population, the most common form of the disease is pulmonary tuberculosis.

In addition to this organ, the following may be susceptible to infection:

• leather;
• musculoskeletal system;
• intestines;
• kidneys;
• liver;
• larynx (organ tuberculosis).

It affects not only the affected organ itself, but also has a detrimental effect on the entire body as a whole. In this case, the action of the digestive system is inhibited, protein, fat and carbohydrate metabolism is disrupted. Mineral metabolism also undergoes changes. In a sick body, there is a significant loss of sodium chloride, calcium and phosphorus. The consumption of vitamins A, C and group B increases significantly, and thus their reserves are depleted.

General principles of diet for illness

Nutritional therapy for tuberculosis plays a significant role in the patient’s recovery process.

Diet therapy must meet the following general requirements:

• promote the development of immunity;
• supply the body with substances that will help fight the harmful effects of the disease, i.e. heal previously developed foci of inflammation;
• normalize the functioning of the gastrointestinal tract, and therefore metabolic processes;
• normalize vitamin and mineral balance in the body.

Squirrels

The benefits of the simplest foods have long been known. In the absence of pharmacological agents, baked milk with oats was the main supplier of protein to the sick body.

In case of acute development of tuberculosis with pronounced symptoms such as fever, nausea, vomiting, dizziness, protein intake should not be significant. In case of chronic tuberculosis, the daily protein intake should be doubled.

This can be achieved by adding dairy products to the diet - such protein is most efficiently absorbed by the body.

Protein entering the affected body has the following positive effects:

• affects scarring of the lesion;
• increases immunity;
• Vitamins, in particular group B, enter the body along with protein foods.

There are a number of products, other than dairy, that contain the largest amount of protein that is beneficial for a sick body. These include:

• eggs;
• lean fish;
• chicken's meat;
• veal.

Are there any benefits from fats?

When creating a menu for tuberculosis, the main rule is to reduce the amount of fat consumed, since it can have a detrimental effect on the digestion process, in which case the liver is primarily subject to serious overload. The amount of fat in the daily diet should not exceed the norm for a healthy person, that is, 100 g/day.

When choosing fat-containing products, it is better to give preference to products of dairy origin, since such fat is easily absorbed by the body and does not cause obesity. It can be:

• sour cream;
• cream;
• butter.

However, you should absolutely avoid pork or lamb fat. Olive or sunflower oil, as well as fish oil, should not be ignored; 1/3 of all fats consumed should be of plant origin.

Carbohydrates in the diet

Proper nutrition for tuberculosis should contain a sufficient amount of carbohydrates, since the function of the pancreas suffers, and its work should be supported. Daily content is up to 500 g (more can lead to obesity).

1/5 of the carbohydrate intake should be consumed in the form of sugar, jam or honey.

Easily digestible carbohydrates contained in bread, flour products, semolina, rice, millet porridge should be in the diet in smaller quantities than those present in vegetables, fruits, potatoes, oatmeal, buckwheat and pearl barley.

Replenishment of vitamins and microelements

How to help a sick body resist infection? One of the necessary steps is to supply the body with vitamins and minerals. This can be done through increased consumption of vegetables and fruits:

If food cannot satisfy a sick person’s need for vitamins (it is especially important to monitor the level of vitamins A, C, D and group B), their synthetic analogues should be taken in tablet or injection form.

For any form of tuberculosis in the decay phase, the daily amount of vitamin C should reach 300-400 mg. It improves tone and supports the body's immune response, neutralizes toxins, which leads to a speedy recovery.

Vitamin C is indispensable for hemoptysis and bleeding, as it reduces capillary permeability and relieves inflammation in tissues.

Salt must be used with caution. If pathological conditions such as bone tissue lesions and renal dysfunction are present, then a special diet for tuberculosis is prescribed to avoid swelling, completely eliminating the use of salt. Fluid intake is reduced to 1 l/day.

Diet is an integral part of therapy

All nutritional recommendations for tuberculosis are taken into account in the diet used in dispensaries. It meets all standards and recommendations of TB doctors. The so-called diet 11 for tuberculosis involves eating the following foods:

Meals should be fractional (up to five times a day). The diet for pulmonary tuberculosis must meet all the requirements of the attending physician. Taking some products on your own can cause significant harm to your health. Contraindications include the exclusion of such nutrients as:

• fatty fish;
• lamb, beef and cooking fat;
• sauces: spicy and fatty;
• buttercream on cakes.

Period of exacerbation of the disease

Nutrition for pulmonary tuberculosis during treatment of the acute stage must meet a number of rules. The body needs to increase the nutritional value of the diet, because in case of illness, protein compounds are subject to rapid breakdown and need to be constantly replenished.

Dietary recommendations include the following healthy foods for tuberculosis:

• fats: 90-100 g/day, proteins: up to 150 g/day, carbohydrates: up to 500-600 g/day;
• increased intake of vitamin C;
• double the consumption of liquids, fresh juices;
• presence of fresh fruits and vegetables in the diet;

All products should be thoroughly ground and taken at short intervals (2-3 hours).

If pulmonary tuberculosis is complicated by pathological conditions associated with the musculoskeletal system and the cardiovascular system, calcium-containing foods (up to 5 g/day) should be added to the diet.

Baby food

A sick child is always a disaster for both parents and doctors. Therefore, for a speedy recovery in children, it is necessary to adhere to a number of rules:

Folk remedies to help your diet

Honey and bee products will have an additional positive effect when added to the menu for tuberculosis.

These products can:

• have an anti-inflammatory effect;
• perform antibacterial functions;
• replenish potassium deficiency.

Products that increase the body's resistance also include kumys, a drink made from mare's milk by fermentation. It contains:

• vitamins C, A, and group B;
• lactic acid;
• carbon dioxide;
• milk sugar.

For patients with a severe form of the disease, the average daily dose is up to half a liter of kumis, for all others - up to one and a half liters per day.

There are contraindications for taking this drink. These include:

Grapes are used as an additional source of nutrition. 1 kg of berries contains up to 180 g of glucose. The patient is allowed to consume up to 2 kg per day. Contraindications will be:

• disorders of the gastrointestinal tract;
• overweight;
• diabetes.

A properly selected and balanced diet will provide significant assistance in the treatment of such a complex disease as pulmonary tuberculosis.

Many doctors predict a new wave of tuberculosis in the near future - the fourth in a row. Doctors have known about the survivability of mycobacteria, or Koch's bacillus, for a long time. Today, not only our country, but the whole world, even the prosperous United States, faces the danger of a tuberculosis epidemic. The tuberculosis outbreak in New York in the early nineties is an example of this...

FOURTH COMING

When antibiotics appeared, many therapists were confident that tuberculosis would soon be defeated. But the harder the mycobacterium was beaten, the more it increased its pathogenicity and, having passed through several weakened and undertreated patients, it transformed beyond recognition. This is how completely new forms (strains) of the tuberculosis pathogen appeared, resistant to certain anti-tuberculosis drugs: some are not sensitive to streptomycin, others to rifampicin, and others to several drugs at once - the so-called multidrug-resistant. These are the most dangerous strains.

Mycobacterium tuberculosis has truly enormous adaptive capabilities.

Of course, science does not stand still. Thanks to molecular genetic research, there is hope for the creation of completely new means of protection against tuberculosis, for example, immunomodulators.

But for now, tuberculosis is still insidious. Unfortunately, it is difficult and expensive to survey the entire population. Fluorography is very informative: with its help it is possible to identify almost 50–55% of patients. However, the method has disadvantages: in addition to the danger of radiation (although devices have appeared where it is reduced by 100 times), it is a very expensive pleasure: to identify one person infected with tuberculosis, you need to spend about 25 thousand rubles.

In addition, there are cases when, without surgery, it is difficult to understand the truth of the tuberculosis disease. There are so-called pulmonary tuberculomas, which were first studied in our country: having a single lesion or even a conglomerate of lesions, a person may not complain of cough, fever, and only sometimes feel weakness. There is still a debate about the diagnosis of tuberculoma. It has been proven that among these formations, 20% are lung cancer, 20–25% are progressive tuberculosis. The remaining formations can remain unchanged for years, becoming more active only in old age, when the immune defense “gives up.”

6 QUESTIONS ABOUT TUBERCULOSIS

Can you get tuberculosis through cow's milk?

Approximately one in ten cases of the disease is represented by extrapulmonary forms of tuberculosis. Mycobacteria can affect any organ of the human body except hair and nails. Most often, it chooses the kidneys, masquerading as traditional kidney diseases, for example, pyelonephritis. According to statistics, every fourth infertility is associated with damage to the genital area by mycobacterium. They often strike the joints and spine. Phthisiologists-ophthalmologists believe that half of those who are blind for an unknown reason have lost their sight due to ocular tuberculosis.

According to statistics, every fourth infertility is associated with damage to the genital area by mycobacterium.

Extrapulmonary forms of tuberculosis are indeed often contracted through food, especially through the milk of sick cows or goats. So be sure to boil fresh milk. Keep in mind that mycobacteria also thrive in cheese and butter.
The traditional source of tuberculosis infection is also the meat of sick cows, sheep, and chickens. Today, about fifty domestic and wild animals, twenty-five species of birds are known from which one can catch tuberculosis. Boil or fry meat purchased second-hand thoroughly.

Chickens with tuberculosis lay infected eggs. It is impossible to distinguish them from normal ones by their appearance. So the most sensible thing is to buy products only in stores or official markets, where they undergo special control.

What to do if, with severe tuberculosis, one lung is completely affected?

Very few medical institutions provide such phthisiosurgical care - for example, in the surgical department of the Central Research Institute of Tuberculosis. Such patients have a lack of oxygen in the blood, a weight loss of 20–50%, and it is clear that the operation is associated with a high risk. The effectiveness of such operations is 68–82%, depending on the severity of tuberculosis. Without surgical intervention, unfortunately, about a third of patients die after 7–8 years. Therefore, the sooner you go to the operating table, the greater the chance of defeating tuberculosis.

Who gets tuberculosis more often?

Of course, consumption is less likely to come to a prosperous home, where people have the opportunity to take care of their health, eat well, look to the future without fear - their immune system is much less likely to malfunction. Among the carriers of tuberculosis there are a lot of homeless people, migrants, former prisoners, socially maladjusted individuals - alcoholics, drug addicts.

There is also a hereditary predisposition to consumption: people from the Caucasus and Central Asia suffer from it much more often than natives of the central zone.

And, of course, those who, due to their profession, come into contact with a large number of people, as well as relatives of tuberculosis patients, are at risk of catching Koch’s bacillus. Especially the elderly.

How do you get infected with tuberculosis?

The pathogen is transmitted by airborne droplets - through sputum, which is sprayed when coughing, talking, laughing, or, when dried, enters the body, as we have already said, with dust. Symptoms of tuberculosis are cough with sputum, sweating, weight loss, fever, weakness, shortness of breath for more than a month. All these manifestations are a serious reason to consult a doctor. Remember: recently onset tuberculosis responds well to treatment.

Be sure to undergo fluorography once a year.

Those traveling to the countries of Asia and Africa need to know that tuberculosis is especially rampant in Somalia and India. But in China, for example, everything is fine. And the most accurate method for recognizing tuberculosis is examining sputum using the bacterioscopic method.

Is the tuberculosis vaccine effective against the disease, and should children have it?

In our country, the BCG vaccine is given to all children 4–7 days after birth, at 6–7 years old and 14–15 years old. With the exception of those for whom it is contraindicated, these are approximately 0.5%. BCG saves you from fatal forms of tuberculosis: tuberculous meningitis, cavernous pneumonia and others.

In the USA, children who are in contact with tuberculosis patients are vaccinated with the same vaccine. Many experts believe that BCG is also a preventive measure against cancer. It is used to treat some forms of cancer.

Every year, schools and kindergartens conduct testing for tuberculosis using the biologically active drug tuberculin - the Mantoux test. Parents should know that in many children the skin at the site of tuberculin injection turns red not due to the disease, but due to BCG vaccination. An individual approach is required here, and a competent specialist will correctly “read” the Mantoux test.

Contraindications for the Mantoux test are allergic manifestations, skin diseases, epilepsy, acute infectious diseases and chronic ones during exacerbation.

Is it dangerous to live in an apartment where a person with tuberculosis once lived?

In an apartment where a patient with tuberculosis lived, especially if he did not comply with hygienic requirements, the causative agent of the disease can persist for a long time. But it can be dealt with. An effective way to treat the room - preferably before and after renovation - is with a disinfectant, for example, a chloramine solution. You can do this yourself, or you can invite specialists from the regional sanitary and epidemiological station. It's good if this apartment is on the sunny side. Sunlight is harmful to mycobacteria.

Tuberculosis(Tuberculosis) is an infectious, predominantly chronic disease of many species of agricultural and wild animals, including fur-bearing animals and poultry, characterized by the formation of specific nodules in various organs - tubercles, prone to cheesy disintegration.

Pathogen – microorganism of the genus Mycobacterium. There are three main types of the causative agent of tuberculosis: 1) M. tuberculosis (human species); 2) M. bovis (bovine species); 3) M. avium (avian). In terms of morphology and cultural properties, they are largely similar to each other; These are thin, straight, often slightly curved rods 0.8–5.5 µm long, located singly or in groups in smears. Branched, filamentous and coccus-like forms of the microbe are also found. The microbial cell membrane contains fatty wax-like substances, and granularity is noted in the protoplasm.

Mycobacteria are strict aerobes, nonmotile, do not form spores or capsules, acid-alcohol-resistant; are stained bright red using the Beale-Neelsen method, and other microflora are stained blue.

To grow the causative agent of tuberculosis, glycerin MPA, MPB, potatoes, egg and synthetic media are used. Cultures grow slowly: human mycobacteria - 20 - 30 days, bovine mycobacteria - 20 - 60, avian - 11 - 15 days. If there is no growth, it is recommended to keep the crops in a thermostat for 3 months.

The pathogenicity of individual types of the causative agent of tuberculosis for different species of animals and humans is not the same. The species of the causative agent of tuberculosis is determined by the characteristics of their growth on artificial nutrient media and by performing a bioassay on guinea pigs, rabbits and chickens.

Sustainability. Mycobacteria are very resistant to various environmental factors and chemicals. This property is explained by the presence of fatty wax substances in the microbial cell. The causative agent of tuberculosis remains viable in manure for 7 months, in dried cow feces for up to a year, in soil for more than two years, in river water for up to 2 months; in meat, frozen and stored in the refrigerator - up to a year, in salted meat - 45 - 60 days, in butter - up to 45, in cheese -. 45 – 100, in milk – up to 10 days. Pasture areas where animals with tuberculosis were grazed remain infected throughout the entire summer period (V.N. Kislenko, 1972).

Heating milk to 70 C kills the tuberculosis pathogen in 10 minutes, and boiling it kills it in 3-5 minutes. The best disinfectants are an alkaline 3% solution of formaldehyde (exposure 1 hour), a suspension of bleach containing 5% active chlorine, a 10% solution of iodine monochloride and a 20% suspension of freshly slaked lime, applied by three times whitewashing with an interval of 1 hour

In addition to the pathogenic mycobacteria of the three named types of the causative agent of tuberculosis (pathogenic mycobacteria), the genus Mycobacterium contains a large group of atypical mycobacteria. Based on their morphological characteristics, they are difficult to distinguish from the causative agent of tuberculosis; they are often represented by coarser, thicker, non-granular rods of different lengths. Atypical mycobacteria are widespread in nature, and many of them are saprophytes. Once in the body of animals, atypical mycobacteria are able to multiply in it, and create short-term sensitization of the body to tuberculin for mammals.

Epizootological data. Many species of domestic and wild animals are susceptible to tuberculosis, including game animals and birds (more than 55 species of mammals and about 25 species of birds). This disease is most often reported in cattle, pigs, minks and chickens; less often - in goats, dogs, ducks and geese; very rarely - in sheep, horses and cats. Monkeys are highly susceptible to tuberculosis. Among wild ungulates, deer are more often affected. Humans also suffer from tuberculosis.

Source The causative agent of the infection is animals with tuberculosis, from whose body the pathogen is excreted in milk, feces, nasal discharge, and sometimes with sperm. When cows are infected with any type of tuberculosis pathogen, mycobacteria are always excreted in the milk.

Transmission factors for the causative agent of tuberculosis can be feed, water, pastures, bedding, manure, etc., contaminated with secretions of sick animals. Young animals are mainly infected through milk and skim milk obtained from sick animals. Intrauterine infection of calves is possible. Animals can become infected with the human species through contact with people with tuberculosis.

The route of infection is predominantly nutritional, but aerogenic cannot be ruled out, especially when patients are kept together with healthy people in closed, poorly ventilated, damp rooms. Tuberculosis spreads relatively slowly among animals. This is explained by the length of the incubation period of the disease (up to 45 days). Inadequate feeding, unsatisfactory living conditions (overcrowding, dampness) and other unfavorable factors reduce the overall resistance of the animal's body and contribute to the rapid spread of the disease. There is no definite seasonality in the manifestation of the epizootic process in tuberculosis. However, in cattle it is more often recorded during the stall period.

Pathogenesis. The causative agent of tuberculosis, having entered the body through the digestive tract with food or inhaled air, penetrates the lungs or other organs. At the site of its localization, an inflammatory process develops, manifested by cellular proliferation and exudation; There is an accumulation of multinucleated giant and epithelioid cells surrounded by a dense layer of lymphoid cells. The exudate accumulated between the cells coagulates, forming a network of fibrin, and an avascular tuberculous nodule is formed - tubercle. It initially has a grayish color and a round shape; its size is from the head of a pin to the size of a lentil grain. Soon the nodule is surrounded by a connective tissue capsule. The tissue inside the encapsulated nodule, due to the lack of influx of nutrients and under the influence of pathogen toxins, dies and turns into a dry crumbly mass resembling cottage cheese (caseosis). In a benign course of the disease, the primary focus undergoes calcification, a dense connective tissue capsule forms around it, and further development of the infectious process stops. In an organism with reduced resistance, the process of pathogen encapsulation in the primary focus is weakly expressed. Due to insufficient regeneration of connective tissue, the walls of the tuberculous nodule melt, and mycobacteria enter healthy tissue, which leads to the formation of many small, translucent nodules (biliary tuberculosis). Small tubercles can merge with each other, forming large tuberculous foci. Mycobacteria from tuberculosis foci can enter the blood, which leads to the generalization of the process and the development of tuberculosis foci of different sizes in various organs (liver, spleen, kidneys, etc.). With a long course of the disease, large tuberculosis foci and cavities can form in the lungs, sometimes reaching the size of a fist. A dense connective tissue capsule grows around them. Tuberculous cavities can communicate with the lumen of the bronchi. In such cases, their contents liquefy and are released when coughing with sputum.

Course and symptoms. Tuberculosis usually occurs chronically, and often without clearly visible signs. A positive reaction to tuberculin in animals occurs on the 14th – 40th day after their infection (incubation period). Most animals with tuberculosis are no different from healthy ones in appearance and general condition, especially at the onset of the disease. Sick animals are identified mainly by allergic and serological testing; tuberculosis lesions are usually detected only during post-mortem examination of organs. As a result of systematic planned examinations of livestock (tuberculinization), it is possible to identify the disease in the initial stage. The appearance of clinically pronounced forms of tuberculosis indicates a long course of the disease. Based on the location of the pathological process, pulmonary and intestinal forms of tuberculosis are distinguished; There are also lesions of the udder and serous integument (pearl oyster), the genital form and generalized tuberculosis. It is conventionally accepted to distinguish between open (active) tuberculosis, when the causative agent of the disease is released into the external environment with milk, feces, sputum when coughing, and closed (latent) in the presence of encapsulated foci without the release of the pathogen into the external environment. When the intestines, mammary gland, or uterus are affected, the process is always considered open.

In cattle, tuberculosis most often affects the lungs. If they are severely affected, they experience a slight increase in body temperature, a rare but severe cough; with a protracted course of the disease, the cough becomes weak, silent, but painful. Expectoration in cattle is almost not observed; bronchial mucus released during coughing is swallowed or excreted through the nose. In sick animals, shortness of breath, decreased appetite, fatness and productivity are noted. Visible mucous membranes are anemic. Auscultation of the lungs reveals wheezing, and percussion reveals areas of dullness. Intestinal damage, which is accompanied by diarrhea, is accompanied by rapid exhaustion and increasing weakness of the sick animal.

Breast lesion The gland is characterized by an enlargement of the suprauterine lymph nodes, which become dense, lumpy, and inactive. In the affected lobes of the udder, compacted painless foci are felt; with significant damage, the configuration of the affected lobe changes. When milking, watery milk mixed with blood or curdled mass is released. In case of damage to the genital organs In cows, increased sexual heat and barrenness are noted, and in bulls, orchitis. In generalized tuberculosis, superficially located lymph nodes (submandibular, prescapular, knee fold, suprauterine) are inactive. Tuberculosis in pigs is asymptomatic. Sometimes an increase in the submandibular and retropharyngeal lymph nodes is observed. Abscesses may appear in the affected nodes, after opening which a purulent-curdled mass is released. With extensive lung damage, coughing, vomiting, and difficulty breathing occur. Tuberculosis in birds occurs chronically, with unclear clinical signs. The generalized form is accompanied by lethargy, decreased egg production, and exhaustion (atrophy of the pectoral muscles). When the intestines are damaged, diarrhea is observed; liver - icteric staining of the mucous membranes and skin. Lameness and tumor-like formations on the plantar surface of the extremities are sometimes noted.

Among fur-bearing animals(foxes, minks, nutrias) tuberculosis most often affects young animals. Patients experience weakness and progressive exhaustion; in the pulmonary form, cough and shortness of breath. Damage to the intestines is accompanied by diarrhea, and the liver is accompanied by icteric staining of the mucous membranes. Foxes sometimes develop long-lasting ulcers on their skin.

Pathological changes. Characteristic of tuberculosis is the presence in various organs and tissues of the animal of specific nodules (tubercles) the size of a millet grain to a chicken egg or more. Tuberculous foci are surrounded by a connective tissue capsule, their contents resemble a dry, crumbly, curdled mass (caseous necrosis). With prolonged illness, tuberculous nodules can become calcified. In ruminants, tuberculosis lesions are most often found in the lungs and lymph nodes of the chest cavity. In the lungs, dense, reddish-grayish lesions are found; on section they are shiny, sebaceous (no necrosis), often with caseosis in the center; sometimes the lesions have purulent foci. Occasionally, caverns of various sizes are found (cows, goats). Lymph nodes are most often affected. They are enlarged, dense, lumpy, with caseous tissue disintegration in the center of the node. When the serous integument is affected, multiple (pearl oyster) dense, shiny tuberculous nodules, reaching the size of a hazelnut, are found on the pleura and peritoneum. The intestinal form of tuberculosis is manifested by round ulcers with roller-shaped edges on the mucous membrane of the jejunum and ileum.

Diagnosis. It is placed on the basis of an analysis of epizootic data, clinical signs and the results of allergic, serological (RSC with tuberculosis antigen), pathological, histological, bacteriological and biological studies. The clinical method for diagnosing tuberculosis is of limited value, since the clinical signs of the disease in animals are not typical enough, and at the onset of the disease they are not present at all.

The main method of intravital diagnosis of tuberculosis is an allergic study. For the study, tuberculin (allergen) is used - a sterile filtrate of killed cultures of the causative agent of tuberculosis. We prepare two types of tuberculin: dry purified tuberculin (DPT) for mammals and dry purified tuberculin (DPT) for birds.

Dry purified tuberculin for mammals (protein purified derivative - PPD) consists of freeze-dried precipitated proteins of the cultural filtrate of the causative agent of bovine tuberculosis, grown on a synthetic nutrient medium. It is used for allergic diagnosis of tuberculosis in all mammals.

Dry purified tuberculin (DPT) for birds is similar in appearance and manufacturing technology to DPT for mammals. It is prepared from the cultural filtrate of the causative agent of avian tuberculosis and is used to diagnose tuberculosis in birds and pigs.

Tuberculinization methods. The main method of intravital diagnosis of tuberculosis in animals is an allergic study using a tuberculin test. In horses, an eye examination method (ophthalmic test) is used. In some cases, in cattle it is placed simultaneously with intradermal. As an additional method for diagnosing tuberculosis in cattle, a simultaneous allergy test is used, which is carried out simultaneously with purified tuberculin for mammals and a purified complex allergen from atypical mycobacteria (CAM).

Animals are tested for tuberculosis from 2 months of age; breeding stock of cattle, buffaloes and camels - regardless of the gestation period; sheep, goats, pigs, deer (deer), horses and donkeys - no earlier than a month after birth.

Place of injection. With the intradermal method of research, tuberculin is administered to: cattle, buffalos, zebu, deer (deer) in the middle third of the neck; For breeding bulls, it is allowed to inject into the skin of the subcaudal fold, for pigs - in the area of ​​the outer surface of the auricle at a distance of 2 cm from its base (on one side of the auricle, PPD for mammals is injected, on the other - PPD for birds). For pigs aged 2–6 months, it is better to inject tuberculin into the skin of the lumbar region, moving away from the spine by 5–8 cm (tuberculin for mammals is injected on one side, for birds on the other), using a needleless injector of the IBV-01 brand. . For goats, sheep, dogs, monkeys, fur-bearing animals (except minks), tuberculin is injected into the area of ​​the inner thigh; mink – intrapalpebrally into the upper eyelid; for camels - into the skin of the abdominal wall in the groin area at the level of the ischial tuberosity; kuram—in the beard; for turkeys - in the submandibular earring; for geese, ducks - in the submandibular fold; pheasants, peacocks, parrots, pigeons, cranes, herons, storks, flamingos - in the area of ​​the outer surface of the lower leg, 1 - 2 cm above the ankle joint. The fur at the site of tuberculin injection is cut (feathers are plucked), the skin is treated with 70% alcohol.

Accounting and evaluation of reaction . In cattle, buffaloes, zebu, camels and deer, they are carried out 72 hours after administration of the drug; for goats, sheep, pigs, dogs, monkeys, fur-bearing animals - after 48; in birds - after 30 - 36 hours. The local reaction to the administration of tuberculin can be assessed as positive or negative.

The reaction is considered positive if a diffuse (without clear boundaries with the surrounding tissue), doughy consistency, painful inflammatory swelling is formed at the site of tuberculin injection, accompanied by hyperemia and an increase in local temperature. In some animals, the reaction manifests itself in the form of a dense, painless, clearly contoured swelling.

Cattle, buffalo, zebu, camels and deer are considered responsive to tuberculin if the above changes are present at the site of tuberculin injection and a thickening of the skin fold of 3 mm or more compared with the thickness of the fold of unchanged skin near the site of tuberculin injection.

Sire bulls tuberculinized in the subcaudal fold are considered to react when an inflammatory swelling forms at the site of tuberculin injection and the skin fold thickens by 2 mm or more.

In goats, sheep, pigs, dogs, monkeys, fur-bearing animals and birds, the reaction is considered positive when a swelling forms at the site of tuberculin injection, and in minks - when the eyelid is swollen.

Tuberculinization by the eye method is carried out twice with an interval of 5–6 days. Tuberculin (3 - 5 drops) is applied with an eye dropper to the conjunctiva of the lower eyelid or to the cornea of ​​the eye (with a retracted lower eyelid). The reaction is taken into account after the first administration after 6, 9, 12 and 24 hours, after the second - after 3, 6, 9 and 12 hours.

It is considered positive if mucopurulent or purulent secretion occurs from the inner corner of the eye, accompanied by hyperemia and swelling of the conjunctiva.

Allergic testing for animal tuberculosis is allowed to be carried out only by veterinary specialists who have completed a special training course, are proficient in the technique of administering diagnostic drugs and have experience in assessing allergic reactions.

The diagnosis of tuberculosis is considered established: when a culture of the tuberculosis pathogen is isolated or when a positive result of a biological test is obtained. In cattle, in addition, the diagnosis is considered established when pathological changes typical of tuberculosis are detected in the organs or tissues of animals.

When positive results of allergic tests for tuberculosis are obtained, the diagnosis of the disease is carried out by slaughtering 3–5 animals with the most pronounced reactions to tuberculin and examining internal organs, bones and lymph nodes. In the absence of typical changes for tuberculosis, pieces of organs and lymph nodes are selected and sent to a veterinary laboratory for bacteriological examination.

All livestock of the herd, including previously reacting animals, are tested with a simultaneous test with tuberculin for mammals and the KAM allergen. In herds, on farms, in populated areas where the disease has already been established, animals that react to tuberculin are recognized as having tuberculosis.

Immunity. In tuberculosis, it is non-sterile, remaining as long as the mycobacteria are in the body. For specific prevention of tuberculosis in young cattle and minks, the dry BCG vaccine (1921 Calmette and Gern), used in medicine, is used. Clinically healthy animals are vaccinated with it.

Prevention and control measures. Measures to combat tuberculosis include the protection of healthy farms from the introduction of the infectious agent from the outside, systematic research in order to timely identify sick animals, the improvement of farms unfavorable for tuberculosis by slaughtering sick animals, the isolated rearing of healthy young animals and the implementation of a set of veterinary, sanitary and organizational and economic measures, aimed at protecting healthy livestock and destroying the causative agent of tuberculosis in the external environment; protecting people from tuberculosis infection.

In order to timely identify animals with tuberculosis and monitor the welfare of farms with regard to this disease, routine diagnostic tests of animals for tuberculosis are carried out annually. Cows, heifers and young cattle from 2 months of age, stud bulls, sows, boars, camels intended for sale for breeding purposes are examined.

Twice a year, cattle from breeding farms and farms supplying animals for stocking livestock complexes, milk and dairy products directly to children's and medical institutions, rest homes or to retail chains, as well as farms territorially bordering on disadvantaged areas, are tested for tuberculosis. tuberculosis points. Cattle belonging to citizens living on the territory of these farms are examined simultaneously with the farm livestock.

On breeding pig farms and in reproductive farms, sows are examined before weaning piglets, and boars - 2 times a year. In other farms, sows, boars and, if necessary, young animals from 2 months of age are examined once a year. Monitoring the welfare of poultry and fur farms for tuberculosis is mainly carried out by inspection and pathological examination of dead and killed animals and birds, as well as by the allergic method. Horses, mules, donkeys and sheep are tested for tuberculosis on farms affected by this disease.

If tuberculosis occurs, the farm (farm) is declared unsafe, quarantine is established and a calendar plan of measures to eliminate the disease is drawn up.

In farms affected by tuberculosis in livestock, buffaloes and reacting animals, they are immediately isolated and slaughtered within 15 days. Young animals born from sick animals are fattened in isolated conditions and sent for slaughter. The remaining animals (not responding to tuberculin) of the unfavorable farm are tested for tuberculosis every 60 days until two negative results are obtained in a row for the group, after which two more control studies are carried out at an interval of 3 months. If negative results are obtained and there are no other indications for tuberculosis, this group of animals is considered healthy.

Calves born from animals from a dysfunctional farm that do not respond to tuberculin are raised in isolation and fed with the milk of healthy cows or neutralized milk (skim milk) of their mothers. At 2 months of age they are examined for tuberculosis using the intradermal method.

Calves that react positively to tuberculin are isolated and after fattening they are slaughtered. Non-responders are examined 2 more times with an interval of 60 days, then after 3 months. If a negative result is obtained for the entire group, they are considered healthy and used for production purposes only within the farm.

The improvement of farms with significant livestock affected by tuberculosis (more than 25% of animals) is carried out by slaughtering unfavorable livestock.

The success of the fight against tuberculosis largely depends on the activities of farm managers, who are called upon to provide the necessary assistance to veterinary specialists in conducting diagnostic studies, disinfection work, implement a set of preventive measures aimed at creating a high sanitary culture in livestock farming, increasing the natural resistance of the animal body, and equipping veterinary facilities - sanitary purposes, strictly comply with the requirements of the instructions for combating the disease.

In areas unfavorable for tuberculosis, it is recommended to create special groups (detachments) of veterinary specialists to carry out work on mass testing of animals for tuberculosis.

Under the terms of quarantine, it is prohibited to keep animals sick with tuberculosis in herds and in common livestock buildings, as well as the organization of any kind of temporary and permanent concentration points and isolation farms for keeping such animals on farms. In areas unfavorable for tuberculosis in cattle, it is not allowed to create off-farm complexes, farms and other enterprises for raising heifers. In all farms in such areas, on-farm farms (departments, teams, plots) should be organized for the isolated rearing of young animals.

Livestock purchased by farms or consumer cooperation organizations from the population living in the territory of farms (settlements) unfavorable for tuberculosis are subject to immediate delivery for slaughter without fattening and fattening (in transit), regardless of weight standards.

It is prohibited to export undisinfected milk obtained from cows of a dysfunctional farm, farm, herd in a populated area, to milk processing plants, for sale in markets, for use in public catering networks, etc. Such milk is subject to primary processing directly on the affected farm (on the farm) for the entire time until the disease is completely eliminated and quarantine is lifted. At the same time, milk obtained from cows with clinical manifestations of tuberculosis is prohibited from being used for food purposes and as animal feed. It is disinfected by adding 5% formaldehyde or another disinfectant to the milk. Given this, sick cows should not be milked. Milk from cows that react to tuberculosis during testing is disinfected by processing it into ghee - raw or by boiling.

Dairy products from non-responsive cows of a dysfunctional herd are disinfected at a temperature of 90 C for 5 minutes or at a temperature of 85 C for 30 minutes.

Dairy enterprises must release skim milk to farms only after it has been disinfected by pasteurization or heat treatment with live steam.

In specialized complexes, on farms for raising heifers (heifers), when a disease is detected in young animals of the technological (age) group in which patients are identified, all heifers of this group are slaughtered within 30 days, the rest of the animal population of the complex, farm - within 6 days. months (no more). Insemination of heifers is prohibited. During the period of recovery, the introduction of heifers from supplying farms into the complex and onto the farm is stopped, and in the future, the addition of new livestock to them as off-farm enterprises for raising heifers is not allowed.

At beef production complexes and other fattening farms, when tuberculosis is diagnosed, all animals in the disadvantaged group are branded with the letter “T” and slaughtered within 15 days. The remaining livestock is examined every 60 days for tuberculosis using the allergic method or the issue of selling all animals of the complex (farm) for meat is decided.

When infection of cattle with the causative agent of avian tuberculosis or atypical mycobacteria is established, as well as when animals that react to tuberculin are detected in a free herd (on a farm), but tuberculosis has not been established in them by previous studies, the herd (farm) is considered free from tuberculosis.