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54. Clinical forms of tuberculosis. Extrathoracic and miliary tuberculosis
1. Extrathoracic tuberculosis
Tuberculosis of the upper respiratory tract. Tuberculosis of the larynx in a child almost always occurs against the background of cavernous pulmonary tuberculosis, its symptoms are persistent cough, sore throat and pain when swallowing, hoarseness of voice.
Tuberculosis of the lymph nodes. The defeat of peripheral and deep lymph nodes is considered a characteristic feature of tuberculosis infection.
In children, the hilar lymph nodes are most often affected first, from which the process can subsequently spread to paratracheal, supraclavicular, deep cervical or intraperitoneal groups of lymph nodes.
Clinical manifestations. Tuberculosis of the lymph nodes usually begins gradually and imperceptibly. Only in children highly sensitive to tuberculosis infection, an acute onset of the disease is possible with an increase in body temperature and the development of local signs of inflammation. Most children have positive tuberculin tests, and chest radiographs show signs of primary pulmonary tuberculosis.
Diagnosis. An accurate diagnosis is possible on the basis of histological or microbiological examination.
Treatment. Tuberculous lesions of the lymph nodes respond well to treatment with isoniazid and rifampicin or ethambutol given for at least 18 months.
2. Miliary tuberculosis
Miliary tuberculosis occurs more often in children under 3 years of age with hematogenous dissemination of mycobacteria with the development of granulomas in many organs that undergo caseous necrosis.
Clinical manifestations. The onset of the disease in children can be acute. Body temperature rises, weakness, malaise, anorexia, weight loss develop. On physical examination, nonspecific changes are noted in the form of lymphadenopathy, enlargement of the liver and spleen. Subsequently, respiratory disorders increase. With the development of meningitis, headaches, lethargy, stiffness of the neck muscles join.
In the case of periodic penetration of a small number of pathogens into the bloodstream, a picture of chronic hematogenous disseminated tuberculosis usually develops, which is more typical for adult patients, and not for children. Its clinical symptoms are short or long periods of fever, weakness, weight loss, growing over a long time.
Diagnosis. Diagnostic methods are:
1) x-ray examination;
2) cultures of blood, urine, gastric contents and cerebrospinal fluid in order to detect myco-bacteria;
3) transthoracic lung biopsy.
Treatment. The appointment of isoniazid and rifampicin in combination with ethambutol or streptomycin is shown.
Author: Pavlova N.V.
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