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The causer da tuberculosis (more necessarily, the pulmonary tuberculosis) is the Mycobacterium tuberculosis(MTB) also known as bacillus of Koch, in homage ao its finder, the German doctor Heinrich Hermann Robert Koch. It is a aeróbica bacterium of the Gram-positive type of slow growth, which if divides to each 16 or 20 hours, what sufficiently slow it is compared with other bacteria whose division if gives in minutes. It is a bacillus (that is, a bacterium in baton form) that it can resist weak deodorants and it can survive in dry way during weeks, however, only obtains to develop itself in the organism of a host. Current the most important tuberculosis is one of infectious illness, that until today affects millions of human beings, and after the sprouting of the AIDS its dissemination it came back to grow. It took time until vitro of the M. was obtained to make tuberculosis cultures in (or MTB), however, currently this is a common laboratorial process. The MTB is identifiable in the microscope after treatment with alcohol-acid solution and coloration (method of Ziehl-Neelsen). In the technique of more common coloration, the bacilli absorb a shining red corante that contrasts well with deep a blue one. The resistant bacilli alcohol-acid also can be visualized by fluorescent microscopy (technique of fluorocromo), and by coloration with auramina-rodamina. The group to which belongs the M. tuberculosis includes 3 other bacterium that also can cause tuberculosis: the Mycobacterium bovis, the M. africanum and the M. microti. The two first ones provoke rare cases of the illness, and last not the cause infection in human beings. The illness Transmission The tuberculosis if spreads through gotículas in air that is expelled when people with infectious tuberculosis tossem, sneezes, speaks or sings. Next contacts (people with drawn out, frequent or intensive contact) have high risk of if infectarem (tax of 22% infection). The transmission only occurs from people with active infectious tuberculosis (and of who it does not have the latent illness). The probability of the transmission depends on the infection degree of the person with tuberculosis and the expelled amount, form and duration of the exposition to the bacillus, and the virulence. The transmission chain can be interrupted isolating themselves patient with the active illness and initiating a therapy efficient anti-tuberculosis. Pathogenicity 10% of the patients with infectious tuberculosis only evolve for the picture of the illness - a well reduced percentage. Infection The infection for tuberculosis if initiates when the bacillus reaches the pulmonary alveoli and can be spread from there for the lymphatic nodules and, through the sanguineous chain for more distant fabrics where the illness can be developed: the superior part of the pulmões, the kidneys, the brain and the bones. The imunológica reply of the organism it kills the majority of the bacilli, leading to the one formation granuloma. The "tubercles", or tuberculosis nodules are small injuries that consist of dead fabrics of acinzentada color contend the bacterium of the tuberculosis. Normally the imunológico system is capable to contain the multiplication of the bacillus, preventing its dissemination in 90% of the cases. The illness However, in some people, the bacillus of the tuberculosis surpasses the defenses of the imunológico system and starts if to multiply, resulting in the progression of a simple infection for tuberculosis for the illness in itself. This can occur soon the infection after (primary tuberculosis - 1 5% of the cases), or some years after the infecção(reativação of the tuberculosa illness, or bacillus dormente - 5 9 %). About 5% of the infectadas people they go to develop the illness in the two first years, and others 5% go to develop it still more late. In the total, about 10% of the infectados ones with normal imunológico system they will develop the illness during the life. Some situations increase the risk of progression of the tuberculosis. In people infectadas with the HIV Diagnosis A complete medical evaluation for the TB includes a description, a physical examination, the subcutaneous test of Mantoux, a ray-x of the thorax medical and study under microscope and microbiological cultures. Medical description The medical description includes the attainment of symptoms of the pulmonary tuberculosis (TB): cough intense and drawn out per three or more weeks, pain in the chest and hemoptise. Sistêmicos symptoms include nocturnalfever, calafrios , sweats, appetite loss and weight, and easy fatigue. Other parts of the medical description include previous exposition to the tuberculosis, in the form of infection or illness; previous treatment of TB; demographic factors of risk for the TB; e medical conditions that increase the risk of infection for tuberculoses, such as the infection for HIV. It must be suspected of tuberculosis when persistent a respiratory illness - in an individual that de.outra.forma would be healthful - will not be answering to regular antibiotics. Physical examination A physical examination is made to evaluate the general health of the patient and to discover other factors that can affect the plan of treatment of the TB. It cannot be used as diagnostician of the TB. Raio-x of the thorax A posterior and previous ray-x of the thorax is traditionally made; other sights (lateral or lordótico) or images of computerized cat scan can be necessary. In active pulmonary TB, infiltrations or consolidations and/or socket frequently they are seen in the superior part of the pulmões with or without linfadenopatia (illness in the lymphatic nodules) mediastinal or hilar. However, injuries can appear in any place in the pulmões. In people with HIV and other imuno-suppressions, any abnormality can indicate the TB, or the ray-x of the pulmões can even though seem entirely normal. In general, the tuberculosis previously treated appears in the ray-x as pulmonary nodules in the area to hilar or the superior lobes, presenting or not fibróticas marks and loss of volume. Pleurais Bronquiectastia (that is, dilatação of the bronchis with the presence of catarro) and marks can be gifts. Nodules and fibróticas scars can contain bacilli of tuberculosis in slow multiplication, with potential to be progressed for one future active tuberculosis. Individuals with these characteristics in its examinations, will have a positive test of subcutaneous reaction to the tuberculina, must be considered candidates of high priority to the treatment of the latent, independent infection of its age. In opposing way, injuries to granulate calcificadas (granulomas calcificados) present baixíssimo risk of progression for an active tuberculosis. Abnormalitys detected in x-rays of the thorax can suggest, however, never are accurately the diagnosis, of a TB. However, these x-rays can be used to discard the pulmonary possibility of tuberculosis in a person who has positive reaction to the tuberculina test but that she does not have the symptoms of the illness.
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