Tuberculosis is one of the most ancient and widespread diseases. Changes in the tubercular character were discovered during excavations in the bone remains of Stone Age people and Egyptian mummies. Doctors of ancient centuries identified a specific symptom of this disease. It was characterized by the presence of a strong cough with sputum, frequent hemoptysis and fever. The rapid progression of the process leading to the depletion of the patient, and hence came the name “consumption” from the word “wither” and “Phtisio” meaning in Greek (phthisis) “exhaustion”, “destruction”. At that time, there arose the notion of tuberculosis infection and the hereditary predisposition to it. isolation of TB patients on a par with leprosy patients in India were forbidden marriage with sick with tuberculosis or from families in which there were such patients to prevent the spread of the disease in Persia was conducted.

The development of the doctrine of tuberculosis can be conditionally divided into three periods:

1.empirichesky – when basic knowledge about tuberculosis relied on clinical observations, the longest, from antiquity to the early 18th century.

period of clinical anatomy from the 18th century to the early 19th century
the period of the functional direction – is connected with the achievements of physics and microbiology, the discovery of a causative agent of tuberculosis by Kokh. This period is divided into: a. – doantibacterial (from the end of the 19th century to the 40s of the 20th century); b-an antibacterial period that began in the 50s of the 20th century.
The first description of the disease that we call tuberculosis, can be found in the writings of Hippocrates (460-377 gg. BC). He pointed out that people with a young age are more likely to develop this ailment, and adverse meteorological factors are a predisposing factor.

In the writings of Abu Ali Ibn Sina (Avicenna) (980-1037), there is a description of the clinical signs of tuberculosis, emphasizes the importance of clinical signs of tuberculosis, the state of the body for the course of the disease and indicates the possibility of cure. The study of the materials of pathoanatomical sections and the accumulation of clinical observations significantly deepened the knowledge of tuberculosis. The study of the morphological changes in various organs in this disease enabled the Leiden anatomist Silvius de la Boée (1614-1672) to suggest the connection of the tubercles found in various organs with tuberculosis, but Silvius identified the tubercles in the lungs as altered lymph nodes and did not consider them morphological substrates disease. Similar views were held by Richard Morton, who in 1689 wrote the first monograph on tuberculosis called “Phthisiology, or a treatise on consumption.” Beyle (1774-1816) described in 1810 the nature of tubercles in the miliary form of tuberculosis and recognized them as the basis of the disease. A more detailed description of the pathoanatomical and clinical changes in tuberculosis was made by the French scientist Laennec (1781-1826); he also introduced the term “tuberculosis” for the first time. In his classic work “On Auscultation and Diagnosis of Lung and Heart Disease” (1819), he notes that the presence of tubercles in the lung is the cause of pulmonary tuberculosis and constitutes its anatomical basis. Laennec believed that there are two anatomical forms of tuberculosis: isolated tubercles and infiltrates. A great contribution to phthisiology was made by Russian scientists. GI Sokolsky in his work “The Doctrine of Infantious Diseases” (1838) described the disseminated, infiltrative and cavernous forms of tuberculosis. In the treatment of patients, he attached great importance to diet and favorable climatic conditions. Pathomorphological studies of NI Pirogov significantly expanded knowledge about the essence of the tuberculosis process and approved the clinical-anatomical direction in medicine. In 1852, he described giant cells in a tuberculous tubercle. NI Pirogov reflected in his works the clinical manifestations of acute miliary tuberculosis, its typhoid form. He studied and described the tuberculosis of bones and joints. He considered tuberculosis as a common disease, and from these positions he proposed a method of treatment. Wilmen’s experimental works published in 1865 proved that tuberculosis is an infectious disease. Wilmen’s experiments consisted of the following: he injected animals through the respiratory tract with sputum and blood of people suffering from tuberculosis. In 1882, Koch (1843-1910) isolated bacilli of tuberculosis. Domestic scientists (AI Abrikosov, VG Shtefko, AI Strukov, AN Chistovich), and also most foreign researchers, also most foreign researchers considered tubercular inflammation as a single process, including the phases of alteration, exudation and proliferation.

GA Zakharin (1829-1897) considered both endogenous and exogenous occurrence of reinfection possible, but he linked the development of the disease with the poor sanitary and hygienic conditions in which the patient lived, with severe illnesses, with an incorrect lifestyle. SP Botkin (1832-1899) attached great importance to social factors in the spread, flow and outcome of tuberculosis. AI Abrikosov (1875-1955) believed that tubercle bacilli can be in the air and enter the respiratory system with dust; He attributed great importance to the drip infection. A lot of work in the development of the doctrine of tuberculosis, the organization and creation of a state system for fighting tuberculosis was invested by AA Kisel and VA Vorobyov. AA Kisel believed, tuberculosis disease in children is limited for a long time to the lymphatic apparatus. Based on this view, he described chronic tuberculosis intoxication as an independent form of tuberculosis in children. VA Vorobyov (1864-1951) began his work on the fight against tuberculosis in the early twentieth century. In 1903, he was a member of the Commission for the Study of Tuberculosis under the Pirogov Society, and since 1907 he headed this commission. One of the main tasks of the commission was the development of the Charter and the organization of the All-Russian League to fight tuberculosis. The Russian League for Tuberculosis Control was a public organization engaged in providing assistance to tuberculosis patients and health education activities. The League opened outpatient clinics and small sanatoriums for tuberculosis patients. Preventive measures include the wide dissemination among the population of physical culture, the holding of recreational activities among children of younger ages and schoolchildren, the creation of rational working conditions for adults and recreation.

In the second half of the 1980s, the impression was created that the profession of a phthisiatrician would fall into oblivion from day to day and the army of fighters with consumption would have to look for a new profession. It was then that many changed the signboard “Department of tuberculosis” to “phthisiopulmonology.” However, since the beginning of the 1990s, in Russia, and in many parts of the world, tuberculosis has become a problem again. Tuberculosis has changed and thrown us back in the past century in many of its manifestations. Extensive and transient processes in the lungs, as well as lesions of bones, genitourinary and nervous systems, eyes, lymph nodes, nervous system began to occur more often. The doctor of any profile should remember that tuberculosis does not affect only the hair and nails. The current turn of events prompted us to address our colleagues with discussions about tuberculosis.

The disease is known since ancient times. Classical descriptions of pulmonary tuberculosis were made by such ancient authors as Aretei of Cappadocia, Hippocrates, etc. Abu Ali Ibn Sina listed the main clinical manifestations of tuberculosis – cough, sputum, hemoptysis, exhaustion – but considered him a hereditary disease. The first to directly point out the infectious nature of tuberculosis Girolamo Fracastoro, and Silvius noted the connection of pulmonary tubercles with pulmonary tuberculosis. The variety of clinical manifestations of tuberculosis caused a large number of erroneous ideas; R. Laennec referred pulmonary tubercles to malignant neoplasms, and the great Rudolf von Virchow did not associate caseous necrosis with the tuberculosis process. The growth of cities, crowded population and low sanitary culture led to the fact that in the XVIII – XIX centuries tuberculosis collected abundant harvest among different strata of the population: it is enough to recall FMDostoyevsky, F.Shopen, V.G.Belinsky, A.P. Chekhov, A.M. Gorky and others; moreover, the consumptive form even became fashionable, and the ladies were dragged out into corsets until impossibility, they drank vinegar for languid pallor and instilled a belladonna extract into the eyes for a feverish shine. To the native surgeon N.I. Pirogov belongs to the description of the giant cells contained in the tubercular tubercle made in 1852. The infectious nature of the disease was first proved by Wilmen (1865). The next most important stage in the study of tuberculosis and the improvement of measures to combat it is the report “Etiology of tuberculosis” made by the German bacteriologist Robert Koch at a meeting of the Berlin Physiological Society on March 24, 1882 and allowed the whole world to learn about the causative agent of this disease. In 1982 (on the 100th anniversary of this discovery), WHO and the International Union Against Tuberculosis and Lung Disease (IUATLD) sponsored the first World TB Day (World TV Day) to attract public attention to the disease. In 1998, this day was celebrated as an official event within the UN framework.

In the 1890’s. R. Koch informed the world that he had created a “water-glycerine extract of tubercle cultures”, with the help of which he proposed to treat tuberculosis. It was tuberculin, the introduction of which led to the progression of the disease and even the death of many patients; Now this drug is used for diagnostic purposes. Opening of V.K. X-ray in 1895, X-rays gave an objective diagnosis of tuberculosis of internal organs and bones. The first permanent commission to study tuberculosis in Russia was established in 1900 at the VII Pirogov Congress of Physicians in Kazan.

In 1907, Cesenatico’s pediatrician, Clemens von Pirke, proposed the use of tuberculin Koch (ATC) for skin testing to identify human infection with mycobacterium tuberculosis. And only in 1911, the discovery of mycobacterium tuberculosis by Koch received international recognition and was awarded the Nobel Prize. In 1919 the French Albert Calmette and Camille Guerin, after making 230 crossings of bovine type mycobacteria, inferred the weakened strain, later called the BCG vaccine (from BCQ – bacillus Calmette-Guerin). The first BCG vaccine was given to a newborn in 1921.

Tuberculosis, as a social disaster, required a good organization of the fight against it and public participation. The first anti-TB dispensary, opened in 1887 in Scotland (Edinburgh), became a place of rendering both medical and social assistance to patients. In Moscow, the first free outpatient clinic for tuberculosis patients was opened in 1909. In 1911, in Russia, at the suggestion of A.A. Vladimirova spent the first day of fighting tuberculosis, or the Day of White Chamomile. Then only in Moscow for the needs of patients with tuberculosis was collected more than 150 000 rubles. Since then, white chamomile has become a symbol of Russian phthisiology. And now the system of dispensaries is the basis of the anti-tuberculosis service in the Russian Federation, and in Kazan the Foundation of the White Chamomile was revived in 1998.

The international symbol of phthisiology is a cross depicted on the covers of the leading journals on pulmonary pathology. Tuberculosis was treated with monasteries, here indigent patients could provide care. Treatment.tuberculosis began with good nutrition, rest “on the water” and in mountain sanatoria. More radical methods began to be applied later. In 1882, the Italian Forlanini proposed injecting air into the pleural cavity of tuberculosis patients – impose pneumothorax. In Russia, pneumothorax was introduced by A.N. Rubel in 1910. The turning point in the fight against tuberculosis was the discovery in 1944 of streptomycin by the American bacteriologist Selman Waxman, for which in 1952 in 1944 he was awarded the Nobel Prize. But not all drugs so soon found application in practice. Isoniazid, the leading anti-tuberculosis drug, was synthesized in 1912, but it took 40 years to establish its effectiveness in the treatment of tuberculosis. With the advent of antituberculosis antibiotics and chemotherapy, a real possibility of control over this disease arose.

So, what is tuberculosis?

Tuberculosis (tuberculosis) is an infectious disease caused by mycobacterium tuberculosis (Mycobaclerium tuberculosis) and characterized by the formation of specific granules in various organs and tissues (in the lungs, kidneys, lymph nodes, bones, joints, etc.), and polymorphic clinical picture. The name of the disease comes from the Latin word tuberculum – tubercle. The old names for this disease are tuberculosis and consumption. From the term consumption, the name of the science of tuberculosis-phthisiology, sometimes called phthisiology (if consumption is formed from the Russian verb, is waning, then phthisiology from the Greek phtisis is depletion). Along with the infectious nature, tuberculosis has socio-economic prerequisites for spreading. Outbreaks of tuberculosis are characteristic for wars and epochs of change. It is known that during the First World War in Europe the death rate from tuberculosis was higher than the death rate from injuries. In developed countries, mainly immigrants and lower social strata suffer from tuberculosis.

“White chamomile” is a symbol of the fight against tuberculosis. In April 1911 in Russia for the first time for donations of 150 thousand rubles, the fight against tuberculosis began.

In the development of phthisiology, the stages are distinguished: the first stage is the development of phthisiology before the discovery of the causative agent of tuberculosis, that is, until 1882. The second stage is after the discovery of mycobacterium tuberculosis by Robert Koch.

Arguments of R. Koch (the triad of Koch):

With any form of tuberculosis, the same causative agent, the Koch bacillus, is detected.
The causative agent, introduced into the body of a laboratory animal, causes tuberculosis.
No other pathogen is excreted in any other disease.
The medical officer of the Emperor Napoleon, Laennek, was one of the first to draw attention to the morphological similarity of the structure of the tubercle focus – the so-called tuberculous tubercle.

Since the beginning of the XIX century and now one of the methods for diagnosing tuberculosis is auscultation, the definition of Krenig fields, the height of the apex of the lungs.

Roentgen allowed us to see the pathological process with our own eyes.

In our time, one of the most accurate methods of diagnosis is computed tomography. Eduard Alexandrovich Nechaev, our Minister of Health, promised to allocate funds for the purchase of a computer tomograph, as well as a magneto-resonance tomograph for our institute (according to the lecturer); but, unfortunately, the money is from the mayor, and he will not give them to our institute …

Another method of diagnosis – Pirke test – tuberculin test.

In Russia, the fight against tuberculosis was conducted earlier (in the 16th – 11th – 19th centuries) on the donations of patrons.

At the beginning of this century, 80 people died per day from tuberculosis.

After the victory of the Great October Socialist Revolution, anti-tuberculosis dispensaries began to be established in Russia. Fighters with tuberculosis: Vorobiev, Krasnobaev, Ryabukhin. In our days – Academician of the Academy of Medical Sciences of Russia Khomenko.

In St. Petersburg there are 4 departments of tuberculosis and the Institute of Phthisiology.

Department of pulmonary tuberculosis SIGMU. ac. Pavlova was organized in 1941, in September. It was headed by Abram Yakovlevich Tsygelin.

From 1975 to 1992 the department was headed by Zoya Ivanovna Kostina.

Since 1992, and to this day, its head – Nikolai Andreevich Bragenko.

There are 3 associate professors at the department.

SNO is headed by Assoc. Ivanovsky.

Directions of the department:

Sarcoidosis.
Immunodiagnosis of tuberculosis.
Prevention of tuberculosis.
The famous Russian surgeon of the last century Pirogov said: “It is impossible to separate the academic from the scientific”

In 1882, Robert Koch discovered the causative agent of tuberculosis. The mycobacterium tuberculosis shell consists of 25% lipids. 0 tuberculosis was known for a long time.

Earlier tuberculosis was called consumption. The most sensitive to tuberculosis animals are guinea pigs. Marine surgeon Wilmen processed litter of guinea pigs with phlegm of exhausted seniors, and thus studied the disease in animals.

Conheim injected phlegm into the anterior chamber of the rabbit’s eyes and received tubercular tubercles in the eye 3 weeks later.

Etiology of tuberculosis

The causative agent of tuberculosis is mycobacterium tuberculosis. The causative agent of tuberculosis belongs to a large group of mycobacteria. There are various names of the causative agent of tuberculosis: Koch’s bacillus, Koch’s rods, mycobacterium tuberculosis. There are mycobacterium tuberculosis of human type (typus humanus), bovine (typus bovinus), avian (typus avium). The person is susceptible mainly to the first two types of mycobacteria tuberculosis. Distinctive property of mycobacteria tuberculosis is their acid resistance: they persist in coloring when exposed to acids, alkalis, alcohol. The causative agent of tuberculosis is in the form of a rod with a length of 1.5 to 6 μm and a thickness of 0.2-0.5 μm. Mycobacterium tuberculosis is curved along the length, sometimes arcuate, thickened at one or both ends. In the pathological material they are located sometimes parallel to each other, sometimes at an angle or by piles and clusters of various shapes. Reproduction of mycobacterium tuberculosis occurs by transverse division, branching, budding. Emerging grains form the nucleus of a new cell. In their structure distinguish three surface layers: the first, well-delineated, contributing to the preservation of the shape of the bacterial cell; the second narrow and the third slimy.

Chemical composition of mycobacterium tuberculosis:

Lipids – 20 – 40%. Lipids provide acidity and alcohol resistance of mycobacteria.
Polysaccharides – 1 – 2%. Polysaccharides take part in the reaction of phagocytosis in the lesion.
Tuberculoproteins – up to 50% – cause antigenic activity.
PZZT – hypersensitivity of delayed type. The lipids and polysaccharides of mycobacterium tuberculosis are responsible for PCTF.

In the lung tissue, it is located inside and extracellularly. Fresh elastic fibers in the lung tissue determine its destruction. As we remember from the course of microbiology, it is possible to determine mycobacterium tuberculosis by Tsiol-Nilsson staining, also the luminescent method is very productive.

L-forms of mycobacteria are less virulent, but they are very important when the reactivity of the organism decreases.

In 60% of sarcoidosis, according to Academician Khomenko, L – forms of mycobacterium tuberculosis are determined.

Virulence is a degree of pathogenicity. Virulence is caused both by the physicochemical properties of mycobacteria and by the state of the macroorganism at the time of exposure to mycobacteria. For mycobacteria tuberculosis is characterized by greater resistance to the effects of various physical and chemical agents. In liquid sputum, mycobacterium tuberculosis remains viable and virulent for 5-6 months. Even in a dried state on various objects, linens, books, etc. Mycobacteria can preserve their properties for a number of months and, after falling into favorable conditions of existence, are able to manifest pathogenic activity. Mycobacterium tuberculosis react to changes in conditions of existence and, accordingly, “rebuilt”, change in their qualities and properties. The variability of mycobacteria can manifest itself in the following forms:

a) Morphological variability (flask, diphtheria, branching);

b) tinctorial variability – changes in relation to coloring matter;

c) cultural variability – a change in the morphology and color of crops with growth on artificial nutrient media;

d) biological variability – a change in the degree of virulence upward or, conversely, a decrease in it, up to a complete loss of virulence. Various forms of variability, transformation, pursue a specific goal – the survival of mycobacteria under adverse conditions, persistence of vitality or, as they say, “persistence.” The researchers paid special attention to such manifestations of the variability of mycobacterium tuberculosis as granular forms of them, filtering forms, and in recent years – drug-resistant and L-forms.

Types of mycobacteria tuberculosis (the most dangerous are 1, 2, and 3 types):

Human.
Bullish.
Avian.
Mouse.
The cold-blooded.
There are 3 links of a complex epidemiological chain:

Source (sick person, sick animals)
Transmission paths:
Susceptible collective.
According to statistics, every hundredth egg is infected with tuba