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1IMPLEMENTAREA STRATEGIEI DOTSDE CONTROL AL TUBERCULOZEIN ROMNIATUBERCULOZACURSPENTRUSTUDENIROMNIA, 20052Lucrare aprut n cadrul programului Combaterea tuberculozei: un rspuns cuprin-ztor, coordonat, multisectorial n Romnia finanat din fonduri nerambursabile acordateRomnieidectreFondulGlobaldeCombatereaSIDA,TuberculozeiiMalariei,prinacordul bilateral dintre Guvernul Romniei i aceast instituie de finanare.Material realizat de:Dr. Drago BUMBCEA (UMF Carol Davila, Bucureti)Dr. Lucica DIIU (Biroul OMS Balcani, Bucureti)Dr. Claudia TOMA (UMF Carol Davila, Bucureti)Dr. Cornelia TUDOSE (UMF Carol Davila, Bucureti)Cu contribuia:Prof. Ioan Paul STOICESCU (Institutul de Pneumologie Marius Nasta, Bucureti)Prof. Emil CORLAN (UMF Carol Davila, Bucureti)Prof. Miron Alexandru BOGDAN (UMF Carol Davila, Bucureti)Prof. Traian MIHESCU (UMF Gr.T. Popa, Iai)Prof. Voicu TUDORACHE (UMF Victor Babe, Timioara)Prof. Cristian DIDILESCU (Institutul de Pneumologie Marius Nasta, Bucureti)Prof. Marcel POPESCU (UMF Lucian Blaga, Sibiu)Prof. Gabriela JIMBOREAN (UMF Trgu Mure)Conf. Constantin MARICA (UMF Carol Davila, Bucureti)Conf. Monica POP (UMF Iuliu Haieganu, Cluj Napoca)Conf. Mimi NIU (UMF Craiova)Dr. Oana ARGHIR (Universitatea Ovidius, Constana)Dr. Irina STRMBU (UMF Carol Davila, Bucureti)Dr. Anca MACRI (UMF Carol Davila, Bucureti)Dr. Domnica CHIOTAN (Institutul de Pneumologie Marius Nasta, Bucureti)Dr. Antonela DRAGOMIR (UMF Carol Davila, Bucureti)Dr. Victor SPNU (UMF Carol Davila, Bucureti)Dr. tefan MIHICU (UMF Victor Babe, Timioara)Dr. Doru CIOBANU (Universitatea Transilvania, Braov)Dr. Marilena CRIAN (Universitatea Oradea)Dr. Gheorghe NINI (Universitatea de Vest Vasile Goldi, Arad)Dr. Olimpia NICOLAESCU (Universitatea Titu Maiorescu)3I. ELEMENTEGENERALE ........................................................................................................... 51. Definiie ............................................................................................................................... 52. Scurt istoric ........................................................................................................................ 53. Etiologie .............................................................................................................................. 54. Transmiterea infecieituberculoase................................................................................. 6a. Surse de infecie ............................................................................................................ 6b. Transmiterea infeciei ..................................................................................................... 65. Istoria natural a infeciei tuberculoase .......................................................................... 7a. Primoinfecia .................................................................................................................. 7b. Tuberculoza boal.......................................................................................................... 8c. Istoria natural a tuberculozei n populaie .................................................................... 86. Leziuni morfologice n tuberculoz.................................................................................. 9a. Leziunimicroscopice...................................................................................................... 9b. Leziunimacroscopice................................................................................................... 10II. METODENDIAGNOSTICUL TUBERCULOZEI ................................................................... 111. Examenulbacteriologic ................................................................................................... 11a. Probe clinice................................................................................................................. 11b. Examenulmicroscopic ................................................................................................. 11c. Culturamicobacteriilor ................................................................................................. 13d. Testarea sensibilitii la medicamente antituberculoase ............................................. 13e. Metode moleculare de detecie a MTB ........................................................................ 132. Examenulhistopatologic................................................................................................. 133. Testarea cutanat tuberculinic ..................................................................................... 14a. Tehnic......................................................................................................................... 14b. Citire ............................................................................................................................. 14c. Interpretare................................................................................................................... 14d. Limitele interpretrii ...................................................................................................... 15III. TUBERCULOZACOPILULUI ................................................................................................. 161. Tuberculozaprimar ........................................................................................................ 16a. Manifestri .................................................................................................................... 16b. Diagnostic .................................................................................................................... 17c. Evoluie.Complicaii ..................................................................................................... 172. Tuberculozapulmonar................................................................................................... 173. Forme grave de tuberculoz ........................................................................................... 18a. Meningitatuberculoas ................................................................................................ 18b. Tuberculoza miliar ...................................................................................................... 184. Alte forme de tuberculoz extrapulmonar ................................................................... 185. Diagnosticul tuberculozeicopilului ............................................................................... 19IV. TUBERCULOZAPULMONARAADULTULUI .................................................................... 201. Manifestrileclinice ......................................................................................................... 202. Semneradiologice ........................................................................................................... 203. Diagnosticultuberculozeipulmonare ............................................................................ 224. Diagnosticul diferenial altuberculozei pulmonare ..................................................... 22a. Tuseapersistent......................................................................................................... 22b. Imagine cavitar ........................................................................................................... 235. Evoluia tuberculozeipulmonare.................................................................................... 23V. TUBERCULOZAEXTRAPULMONAR(TBEP) .................................................................... 241. Tuberculozadiseminat .................................................................................................. 24a. Tuberculoza miliar ...................................................................................................... 24b. Tuberculoza diseminat areactiv ............................................................................... 252. Meningitatuberculoas ................................................................................................... 253. Pleureziatuberculoas .................................................................................................... 27CUPRINS44. Tuberculozaganglionar................................................................................................. 285. Tuberculozaosteoarticular ........................................................................................... 28a. Spondilita tuberculoas (morbul lui Pott) ..................................................................... 28b. Tuberculozaarticular.................................................................................................. 296. Tuberculozaurogenital.................................................................................................. 29a. Tuberculoza renal ...................................................................................................... 29b. Tuberculozagenital .................................................................................................... 297. Pericarditatuberculoas ................................................................................................. 298. Alte localizari ....................................................................................................................30a. Tuberculozaperitoneal............................................................................................... 30b. Tuberculozalaringian................................................................................................. 30c. Localizri foarte rare .................................................................................................... 30VI. TUBERCULOZA IINFECIA HIV......................................................................................... 311. Diagnostic ......................................................................................................................... 31a. Circumstane de diagnos