8.3. The dispensaries groups of tuberculosis patients


When at the patient diagnosis of tuberculosis is identified, he is registered by dispensary for the control: at reversibility of tuberculosis – up to clinical cure, and at irreversibility of tuberculosis – up to the end of life. The dispensaries contingents grouping is based on treatment and epidemiological principles and allows the local doctor – phthisisatrist:

  1. to form correctly groups of supervision;
  2. to perform examinations in well-timed periods;
  3. to define medical tactics;
  4. to carry out rehabilitative and preventive measures;
  5. to solve questions contingent movement according registration groups;
  6. to withdraw patients from dispensary registries.

Group zero – (0)
In zero group the following persons are supervised:

  1. with unspecified activity of tubercular process
  2. those requiring differential diagnostics with the purpose of establishment of the diagnosis of tuberculosis of any localization.

The persons, whose specification of tubercular changes activity is necessary, are included in group zero A (a subgroup 0-A).

The persons for differential diagnostics of tuberculosis and other diseases enlist in zero–B – a subgroup (0-B).

First group (I).
In the first group the patients with active forms of tuberculosis of any localization are observed. Allocate 2 subgroups:

  • First – (I – А) The patients with revealed disease for the first time;
  • First – (I – B) with of a tuberculosis relapse.

In both subgroups assign patients with MBT expectoration (I-А – МБТ +, I-Б – МБТ +) and without MBT expectoration (I-А – МБТ-, I-Б – МБТ-). In addition allocate the patients (I-В), which have interrupted treatment or were not supervised after treatment completion (the result of their treatment is unknown).

Second group (II).
In the second group the patients with active forms of tuberculosis of any localization with chronic current of tuberculosis disease are observed.
This group includes two subgroups:

  • second – (II-A) – patients, at which due to intensive treatment can be achieved clinical recovery;
  • second – (II-A) – patients with far advanced tuberculosis process, whose treatment can not be achieved by any methods and patients who require supporting, symptomatic treatment and periodic (at occurrence of the indications) anti-tuberculosis therapy.

Third group (III)
In the third group (control group) the patients with cured tuberculosis of any localization with large, small or without residual changes are registered.

Fourth group – (IV).
In the fourth group the patients who are in contact to sources of tubercular infection are under supervision. The group is subdivided into two subgroups:

  • Fourth – (IV-A) for the persons who are in household and industrial contact to a source of tubercular infection;
  • Fourth – (IV- B) for the persons who are in professional contact to a source of tuberculosis infection.

Some questions dispensaries tactics of supervision and monitoring.

Definition of activity of tubercular process.
Tuberculosis of doubtful activity.
To tuberculosis of doubtful activity refer tubercular changes in lungs and other organs, which activity is not clear at present. For accurate definition of tubercular process activity the (0-zero) subgroup of dispensary monitoring is allocated, which assignment consists in realization of a package of diagnostic measures. The basic package of diagnostic measures should be organized within 2-3 weeks. The patients of zero group can be moved into the first group or to be moved to public health establishments.

Active tuberculosis.
Specific inflammatory process caused by MBT and is defined by complex clinical, laboratory and X-ray signs. The patients with active form of tuberculosis require medical, diagnostic, epidemiological, rehabilitative and social support. All patients with active tuberculosis revealed for the first time or with tuberculosis relapse, enlist only in I group dispensary monitoring.

Chronic course of the active tuberculosis forms.
Long term (more than 2 years), including wavy (interchange of subsides and aggravations) of tuberculosis, at which clinical, radiographic and bacteriological signs attributes of active tuberculosis r process remain. The chronic course of active tuberculosis arises owing to late revealing of disease, inadequate and not regular treatment, peculiarities of immunologic status of an organism or presence of accompanying diseases complicating course of tuberculosis.

Clinical cure.
Disappearance of all signs of active tubercular process as a result of the carried out basic course of combined treatment. Verification of clinical cure of tuberculosis and moment of effective combined treatment end are defined by absence of positive of tubercular process signs within 2-3 months. Monitoring time of the first group should not exceed 24 months, including 6 months after effective surgical treatment.

Patients discharging MBT.
The patients with active form of tuberculosis, at which MBT are revealed in pathologic material and in biological fluids of organism, secreted into external environment. From the patients with out lung tuberculosis to patients discharging MBT allocate persons, at which MBT are revealed in excreted material from fistulas, urine, menstrual blood or excretions of other organs. As the patients discharging MBT are not taken into account those at whom MBT were revealed at inoculation of punctuate, biopsy or operational material. With the purpose of ascertainment MBT expectoration, from each patient before treatment sputum (bronchial waters) and another pathological must be thoroughly examined by means of bacterioscopy and inoculation on medium not less than three times. This observation must be repeated during treatment monthly up to disappearance of MBT which later should be confirmed by at least two consecutive investigations (with cultural) with intervals per 2-3 months.

Discontinuance of MBT discharge abacilarization) – disappearance of MBT in biological fluids and pathological fluids, discharged to external environment. Abacilarization must be proved by two negative consecutive bacteriologic and cultural examinations with an interval per 2-3 months after the first negative analysis.

Residual post-tuberculosis lesions.
To residual lesions refer dense calcinated focuses of various size, fibrotic and cirrhotic changes (including residual satisfied cavities), pleural depositions, post-operational changes in lungs, pleura and in other bodies and organs and also functional disturbances after clinical cure. Isolated (up to 3 cm) fine (1 cm), dense and calcified focuses limited fibrosis (limited by 2 segments) regard as small residual changes. All other residual changes consider large.

Destructive tuberculosis is the active form of tubercular process with presence of tissue disintegration determined by combined of X-ray examinations. X-ray examinations (general view X-ray films and tomograms) are basic method of destructive changes showing up in organs and tissues. As closing (healing) of cavity consider its disappearance confirmed by methods of radio diagnostics.

Aggravation progression of tuberculosis is the occurrence of new signs of active tubercular process after period of improvement or grows progressively worse of illness signs before the diagnosis of clinical cure. The occurrence of an aggravation testifies to inefficient treatment and requires its correction.

Appearance of active tuberculosis signs among patients, earlier suffered from tuberculosis and cured from it, observed in III group or withdraws in connection with recovery. Occurrence of active tuberculosis signs in the spontaneously recovered persons earlier who were not registered in anti-tuberculosis dispensaries, regard as new disease.

The formulation of the diagnosis.
The example:

  1. Infiltrative tuberculosis of the upper lobe of the right lung (S2) in a phase of disintegration and dissemination, MBT +.
  2. Tubercular spondilitis of thoracic vertebra with its body destruction of Th 8-9, MBT-.
  3. Cavernous tuberculosis of the right kidney, MBT +.

When the patient is moved into II group (with chronic course of tuberculosis) that clinical form of tuberculosis is specified, which takes place at the present moment. At the moment of registration there was infiltrative form of tuberculosis. At adverse course of the disease fibrous-cavernous lung tuberculosis developed (or gross tuberculoma is remained with disintegration or without it). In transition epicrisis the diagnosis of fibrous-cavernous lung tuberculosis (or tuberculoma) should be specified. While transition of the patient in control registry group (III) the diagnosis formulate by the following principle: clinical cure of this or that form of tuberculosis (the heaviest diagnosis is set out for the period of illness) with presence of residual post tuberculous changes (large and small) as (character and prevalence and character and residual changes should be specified).


  1. Clinical cure of focus lung tuberculosis with presence of small residual post-tuberculous changes in the form of as fine, isolated, dense focuses and limited fibrosis in the superior lobe of the left lung.
  2. Clinical cure of the disseminated lung tuberculosis with presence of large residual post-tuberculous changes in the form of Widespread, numerous, dense, fine focuses and spread fibrosis in the superior lung lobes.
  3. Clinical cure of lung tuberculoma with presence of the large residual changes in the form of scars and pleural thickenings after limited resection (S1, S2) of the right lung.

For the patients with out lung tuberculosis the diagnoses are formulated by the same principle.

  1. Clinical cure of tubercular colitis on the right with partial infringement of joint function.
  2. Clinical cure of tubercular gonitis at the left with outcome into anchylosis.
  3. Clinical cure of tubercular gonitis on the right with residual changes after operation – anchylosis of the joint.

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