Infectious diseases. Clinical forms of tuberculosis. Progressive primary pulmonary tuberculosis (most important)

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Infectious diseases. Clinical forms of tuberculosis. Progressive primary pulmonary tuberculosis (most important)

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53. Clinical forms of tuberculosis. Progressive primary pulmonary tuberculosis

tuberculosis reactivation. Effusion in the pleural cavity

1. Progressive primary pulmonary tuberculosis

In some cases, the primary focus formed in the lungs does not heal, but increases in size. Damage to the entire lower or middle lobe of the lung may develop. Typically, this course of the disease is observed in patients with suppressed immunity. The increase in intrathoracic lymph nodes in such patients is natural, endobronchial spread of infection and the development of destructive changes in the lungs are often observed. Clinical symptoms are pronounced: febrile body temperature, malaise, anorexia, weight loss, cough with sputum. Physical examination and radiographs reveal hilar adenopathy, inflammatory changes in the middle or lower lobes of the lungs, and cavern formation. The diagnosis must be confirmed by bacteriological data.

2. Reactivation (reinfection) of tuberculosis Reactivation of tuberculosis (or "adult" tuberculosis) is not typical for childhood, especially with the development of primary tuberculosis at the age of about 3 years. Lesions in these cases are localized in the apical and dorsal segments of the upper lobes or in the apex of the lower lobe. An increase in hilar lymph nodes is rare. The most characteristic symptom is subfebrile temperature and night sweats due to a decrease in temperature. On physical examination, gentle rales are found predominantly in the apical regions of the lungs, especially after coughing. The earliest radiographic findings are usually homogeneous, well-demarcated opacities at the apex of the lungs.

3. Pleural effusion

The development of pleurisy can occur as a result of the penetration of tuberculosis mycobacteria into the pleural cavity from peripherally located tuberculosis foci in the lung, as a result of hematogenous dissemination of the pathogen.

It is bilateral, accompanied by pericarditis and peritonitis. Often these lesions resolve spontaneously. Often, a few years after suffering pleurisy, patients observe reactivation of pulmonary tuberculosis. Such patients are shown prophylactic administration of anti-tuberculosis drugs.

A biopsy of the pleura should be performed in all cases and preferably at the same time as the first pleural puncture. In the absence of effusion in the pleural cavity, pleural biopsy is difficult. Histological examination of the pleural biopsy material in most cases reveals granulomatous changes. The appearance of pleural effusion in children with positive tuberculin reactions in all cases should raise the suspicion of tuberculosis and serve as the basis for an appropriate examination. Similarly, pleurisy of unknown etiology in a child with negative tuberculin tests requires a repeat tuberculin diagnosis after 2-3 weeks.

Author: Pavlova N.V.

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