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Primary tuberculosis

LECTURE

doc. Kravchenko N.S.


Tuberculosis which develops in primary infected people is called
primary tuberculosis. It is diagnosed often in children and teenagers.
More rarely in young people.

Topical sings of primary tuberculosis are:


a) The intensity tuberculin test reaction;
b) lesion of lymphatic system (especially lymphatic nodes);
c) tendency to lymphogenous and hematogenous dissemination;
d) state of hypersensibilization of organism to pathogenic agent;
e) possibility of spontaneous recovery.

Tuberculin skin conversion is the appearance of first positive tuberculin


reaction after a negative one within a year or its increase in persons
vaccinated.
The period from the moment of the intensity of tuberculin reaction
during one year without signs of intoxication is called the period of
early tuberculous infection.
Primary tuberculosis usually displays
in three main forms:
- tuberculous intoxication in children and
teenagers (tuberculosis without
established localization);
- primary tuberculous complex;
- tuberculosis of intrathoracic lymphatic
nodes.
PATHOGENESIS IN CHILDREN
Primary tuberculosis is always result of exogenous infection.
The infection penetrates into organism by:
- aerogenic (the most often way of penetration)
- alimentary;
- contact way.
1. The primary complex of tuberculosis consists of local disease at the
portal of entry and the regional lymph nodes that drain the area of the
primary focus. In more than 95% of cases the portal of entry is the
lung. M. tuberculosis within particles larger than 10 (xm usually are
caught by the mucociliary mechanisms of the bronchial tree and are
expelled. Small particles are inhaled beyond these clearance
mechanisms. However, primary infection may occur anywhere in the
body.
2. Ingestion of milk infected with bovine tuberculosis can lead to a
gastrointestinal primary lesion.
3. Infection of the skin or mucous membrane can occur through an
abrasion, cut, or insect bite.
Tuberculous intoxication in children and teenagers is a

clinical form of primary tuberculosis, which is characterized

by complex of symptoms of functional derangement without

local manifestation of disease.

Morfological substrat of tuberculous intoxication are

minimal specific (tuberculous granuloma with areas of

microcaseose) and paraspecific changes, usually in

lymphatic system.
ERYTHEMA NO DOSUM
Differential diagnosis.

It is necessery to exclude diseases accompanied by


intoxication: chronical sourses of infection of oral cavity and
epipharynx, chronical tonsillitis, pielonephritis, rheumatism,
hepatocholecystitis, helminthic invasions.

Main diagnostic criterions of tuberculous intoxication are:


- tuberculin skin conversion
- symptoms of intoxication
- absence of roentgenological changes
- excluding of intoxication with different ethiology

Treatment.
Isoniazidum 10mg/kg of weight + rifampicinum10 mg/kg +
ethambutol 20mg/kg for 4-6 months, vitamins B1, B6, C.
Primary tuberculous complex

Primary tuberculous complex is characterized by


development of specific general changes in lungs (primary
effect), lesion of intrathoracic lymphatic nodes and
lymphangitis.
Patological anatomy: zone of tuberculous granulations and
caseous necrosis is forming in lungs. Zone of perifocal toxic
edema and serofibrinous inflammation is forming around zone
of specific inflammation. These changes form primary affect.
Infection extence in lymphatic vessels from primary affect to
the root of lungs (lymphangitis) and injury of root lymphatic
nodes is taking place (lymphadenitis).

fig. 1
fig.1 Primary tuberculous complex
Clinical manifestations.

Asymptomatic course of disease can be present under little specific


changes in lungs. Complaints: subfebrile temperature, decrease of
body weight, bad appetite, quick tiredness. Coughing happens seldom.
Inspection: paleness, decrease of skin turgor, paraspecific changes,
micropolyadenitis. These changes can be absent.
Percussion: dullness over lung component with a big size.
Weakend breathing with streached exhale.
Hemogram: Leucocytosis 10-13 T/l, insignificant shift to the left,
lymphopenia, monocytosis, ESR 20-25 mm/h.
Tuberculin test - intensivity of tuberculin reaction, hyperergic reaction.
MBT are rarely to be found.
X-ray diagnostics:
Phases: 1) infiltrative or pneumonic;
2) resorbtion (suction,bipolarities);
3) scarring
4) calcification.
fig. 2 Primary tuberculous complex, infiltration phase
Primary tuberculous complex,
infiltration phase
Phase 1: infiltrative or pneumonic
Phase 2: resorbtion
(suction,bipolarities)
Phase 3: scarring
Phase 4: calcification
Phase 4: calcification
PHASES OF PRIMARY
TUBERCULOUS COMPLEX

infiltrative or resorbtion calcification


pneumonic (suction,bipolarities)
Complications are connected with lung component:

If caseation is intense, the center of the lesion may liquefy,


empty into the associated bronchus, and leave a residual
primary tuberculous cavity.

Complications connected with regional lymphadenitis:


- hematogenic dissemination
- lymphogenic dissemination
- pleuritis
- extending of specific process from lymphatic node
Its results:
a) formation of fistula
b) dispersion of caseous masses, bronchogenic
dessemination, bronchi tuberculosis
c) disorder of bronchial permeability, atelectasis
Bronchogenic dissemination
Acute Disseminated Primary TB (often in
children aged under 5 years)
Miliary with or without meningitis
Classified as PTB, Category I
fig. 3 Primary tuberculous complex, complication of atelectasis
Tuberculosis of intrathoracic lymphatic nodes is specific
injury of lymphatic nodes of lungs root and mediastinum.

Pathomorphological forms:
a) hyperplastic
b) caseous form

The clinic of uncomplicated tuberculosis of intrathoracic lymphatic


nodes is similar to that of primary tuberculous complex.

Clinical-radiological forms of tuberculosis of intrathoracic nodes:


1) Small form deformation and strengthening of pulmonary
picture near lung root, decreasing of root structure.
2) Infiltrative root shadow is widened with not clear contour
(ouyline).
3) Tumorshaped widening of mediastinum or lung root with
polycicle clear contour
fig. 5 Tuberculosis of intrathoracic lymphatic nodes
Primary TB Disease:
Often unilateral lymphadenopathy, hilar,
mediastinal, paratracheal or subcarinal
without obvious parenchymal involvement
Most frequent presentation in children (70-80%)
Classify as EPTB and treat as Category III
fig. 4 Roentgenogram of the thoracic cage organs.
Tuberculosis of intrathoracic lymphatic nodes
INFILTRATIVE FORM OF
TUBERcULOSIS OF INTRATHORACIC
LyMPHATIC NODES
TUMOURSIMILAR FORM OF TUBERcULOSIS
OF INTRATHORACIC LyMPHATIC NODES
fig. 6 Roentgenogram of the thoracic cage organs.
Lymphosarcoma, complication of pleurisy
fig. 7 Roentgenogram of the thoracic cage organs.
Lymphogranulomatosis.
fig. 8 Roentgenogram of the thoracic cage organs.
Sarcoidosis of intrathoracic lymphatic nodes.

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