Infectious diseases. Clinical forms of tuberculosis. Intrathoracic tuberculosis (most important)

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Infectious diseases. Clinical forms of tuberculosis. Intrathoracic tuberculosis (most important)

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52. Clinical forms of tuberculosis. Intrathoracic tuberculosis

Pathogenesis and pathomorphology. Primary infection develops most often after inhalation of live virulent mycobacterium tuberculosis. The body of a non-immune child reacts to the penetration of infection with certain cellular reactions. Pathogens are phagocytized by macrophages, in these cells their further reproduction occurs, macrophages bring mycobacteria into regional lymph nodes. Subsequently, lymphogenous and hematogenous dissemination of the infection occurs with the appearance of metastatic foci in the lungs, in the reticuloendothelial system and in other organs.

During this period, when cellular immunity reactions to tuberculosis infection have not yet developed, tissue damage is minimal, and clinical symptoms may be absent. In the vast majority of cases, acquired immunity reactions form 6-10 weeks after infection and are accompanied by recovery, calcification of pulmonary and extrapulmonary foci occurs. Dormant tuberculous infection persists in these residual tuberculous changes, usually located in the apical and subapical regions of the lungs.

Any factors that damage the response of cellular immunity can lead to the reactivation of tuberculosis infection, to the multiplication of pathogens in these foci and the development of pulmonary or extrapulmonary lesions.

Primary pulmonary tuberculosis

Clinical manifestations. In children aged 3 to 15 years, primary tuberculosis is usually asymptomatic, may not be accompanied by changes on chest radiographs, and manifests itself only by a tuberculin test. General symptoms are mild and non-specific, manifested by slight fever, loss of appetite, weight loss, rarely erythema nodosum and phlyctenular conjunctivitis.

Additional symptoms may develop later with a massive increase in intrathoracic lymph nodes, characteristic of a primary tuberculosis infection. In these cases, the enlarged lymph nodes are displaced, squeezed, impair patency or destroy various adjacent organs of the mediastinum. In most children, primary lung infection is mild, asymptomatic, and resolves within a short time even without chemotherapy.

In older children and adolescents, primary pulmonary tuberculosis usually manifests itself as pronounced infiltrative changes in the upper parts of the lungs with the development of destruction, while there are no signs of calcification and enlargement of the intrathoracic lymph nodes. Less commonly, there is a lesion of the middle and lower parts of the lungs with involvement of the intrathoracic lymph nodes, which is characteristic of young children. In younger children, against the background of the described symptoms, a picture of lympho- and hematogenous dissemination may develop, leading to miliary tuberculosis and meningitis.

Author: Pavlova N.V.

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