Primary Tuberculosis

1/4/22, 11:51 AM Primary tuberculosis
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Topic number 15. Primary tuberculosis: prelocal and local

forms. Primary tuberculosis complex. Classification,
diagnostics, clinic, treatment. Clinical analysis of patients.
Primary tuberculosis
Primary tuberculosis is a disease of a previously uninfected
person.
Classification.
I. prelocal forms:
- the early period of primary tuberculosis infection ("bend",
"Infection");
- tuberculous intoxication.
II. Local forms:
- Pulmonary;
- Extrapulmonary.
The most common local forms of primary
tuberculosis:
1. Primary tuberculosis complex:
• asymptomatic form
• typhoid-like form
• pneumonic form
2. Tuberculosis of the intrathoracic lymph nodes:
• small form
• infiltrative form
• tumorous form
Tuberculous intoxication is one of the prelocal forms

primary tuberculosis in children.
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Pathogenesis:
Mycobacterium tuberculosis, entering the body of a young person,
spread through the circulatory and lymphatic system, at first
causing paraspecific lesions. For some reason, these
lesions are not detected. However, with a decrease in resistance
organism, disruption of its defense mechanisms, the syndrome develops
tuberculous intoxication.
Clinic:
Contact with a patient with tuberculosis, the fact of infection for no more than a year,
symptoms of the disease appear before or simultaneously with the "bend"
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tuberculin test, Mantoux test with 2TE positive, often

hyperergic. There is increased excitability, a decrease
appetite, weight loss, at times subfebrile temperature,
micropolyadenopathy (peripheral lymphatic knots
enlarged in several groups, small in size, symmetrical,
soft elastic, painless).
Diagnostics:
Complete blood count - may be mild anemia, moderate
leukocytosis, eosinophilia, lymphocytosis, monocytosis, moderate acceleration
ESR.
X - ray - possible strengthening of the pulmonary pattern, reaction
interlobar pleura.
Differential diagnosis:
held With tonsillitis, sinusitis, adenoids, sinusitis,
frontal sinusitis, helminthiasis, lymphadenopathies of various origins.
Complications:
practically not observed.
Forecast:
favorable. In some patients, in the presence of aggravating
factors, tuberculous infection is transformed into a local form
tuberculosis.
PRIMARY TUBERCULOSIS COMPLEX
Primary tuberculosis complex consists of a specific focus

lesions in the lung tissue, a specific focus in the regional
the lymph node and the specific lymphangitis that connects them
(primary tuberculous affect, specific lymphadenitis and
specific lymphangitis).
Pathogenesis and pathological anatomy:
Primary tuberculous affect in the lung for the most part
localized subpleurally. It is surrounded by a zone of perifocal inflammation,
from the pulmonary focus, the inflammatory process spreads along the
lymphatic vessels and is located in the interalveolar septa,
around the veins, arteries and bronchi. Lymphangitis reaches regional
lymph nodes, in which specific inflammation also occurs
with the formation of curdled necrosis. Over time, the pulmonary component
of inflammation, calcification + melts, forming the Gon focus.
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Clinic:
There are the following forms of primary tuberculosis complex:
asymptomatic, typhoid, pneumonic.
Patients have a variety of clinical symptoms. At
extensive damage to the lung, the disease is often acute: high
fever for 1-2 weeks, severe cough, with objective
the examination reveals pallor of the skin, with percussion -
dullness of pulmonary sound, with auscultation - weakened or
bronchial breathing, and with the development of destruction - listen
moist sonorous wheezing. In addition to specific manifestations, an important place
in the clinical picture of the disease, paraspecific
changes in the skin and mucous membranes.
The primary complex has four stages of development:
Primary tuberculosis complex:

• Stage I - pneumonic (a);
• Stage II - resorption (b);
• III stage - compaction (c);
• IV stage - calcification (d).
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Stage I - pneumonic (Fig. A). The radiograph shows three

components of the complex:
1) focus in lung tissue measuring 2-4 cm in diameter or more, oval or

irregular shape, varying intensity (more often - medium and even
high), with a fuzzy, blurry outline;
2) outflow to the root, lymphangitis, which is defined as linear strands

from focus to root;
3) at the root - enlarged infiltrated lymph nodes. Root
appears to The
increased. be extended,
contours its
thatstructure is blurred,
outline the the intensity
lymph nodes are either blurry or
more clearly outline the enlarged nodes.
Stage II - resorption (Fig. B). The focus in the lung tissue decreases,
its intensity increases, the contours become clear. Decreases
outflow to the root and infiltration of the lymph nodes.
Stage III - compaction (Fig. B). At the focus site, a focus remains up to 1 cm in
diameter, lime inclusions appear in it in the form of small dots
sharp intensity. The same inclusions of lime are noticeable in the lymph nodes.
the root of the lungs. Between the focus and the root, thin strands from
lymphangitis.
Stage IV - calcification (Fig. D). The focus in the lung tissue becomes even
smaller, denser, high intensity, clear outline, often
jagged, uneven. Calcifications also increase in the lymph nodes of the root.
Calcifications in some cases appear to be solid dense
formation, in others they have less intense shadows of inclusions,
which indicate incomplete calcification of the focus and the preservation in them
plots of caseosis. With a favorable outcome of primary tuberculous
complex with time in the center of the former caseoz, located in
peripheral parts of the lungs, calcification is increasing - up to
occurrence in some cases of bone tissue. This is the hearth of Ghosn
(fig. 2).
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Fig 2. The outbreak of Gona
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Rice. 3. CT scan calcinate in the lymph node of the mediastinum
In cases where the primary complex is detected in a timely manner and

the patient receives full treatment, often complete
resorption of pathological changes in the lung tissue and root, with complete
restoration of their original design.
Diagnostics:
When examining sputum, bronchial lavage water, stomach
mycobacterium tuberculosis can be detected when running,
complicated forms of the disease.
Radiographically, during the first phase, intense darkening is observed
in the lung, merging with the shadow of the root, the latter is expanded, in it
the contours of the enlarged lymph nodes are outlined. During this period, expressed
clinical symptoms. In the second and third phase, the size of the shading
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decrease, and a symptom of "bipolarity" appears: clearly

pulmonary and glandular components and the linear shadow connecting them
lymphangitis. In the last phase of the course, pulmonary petrification
glandular components - the centers of Ghosn.
Differential diagnosis:
Most often it becomes necessary to differentiate with
nonspecific pneumonia.
Complications:
1. Complications associated with the pulmonary component:
▪ pleurisy (usually costal and diaphragmatic);
▪ lobar primary caseous pneumonia;
▪ primary cavity;
▪ primary tuberculoma.
▪
▪ Fig. 4. Pleural effusion (2) resulting from rupture
pulmonary component (1) of the primary complex.
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2. Complications associated with the glandular component:

▪ adenobronchopulmonary lesion;
▪ tuberculous meningitis;
▪ dissemination;
▪ bronchonodular fistula;
▪ tuberculous bronchitis;
▪ cicatricial stenosis of the bronchus;
▪ pleurisy (mediastinal, interlobar).
▪ Fig. 5. Thin-walled cavity (1), formed as a result of

destruction by the primary process in the lung of the bronchial wall. Mycobacteria
from this cavity can spread to other parts of the lungs
Forecast:
favorable with timely detection and treatment.

Primary Tuberculosis

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1/4/22, 11:51 AM Primary tuberculosis

Topic number 15. Primary tuberculosis: prelocal and local

Tuberculous intoxication is one of the prelocal forms

tuberculin test, Mantoux test with 2TE positive, often

PRIMARY TUBERCULOSIS COMPLEX

Primary tuberculosis complex consists of a specific focus

The primary complex has four stages of development:

Primary tuberculosis complex:

Stage I - pneumonic (Fig. A). The radiograph shows three

1) focus in lung tissue measuring 2-4 cm in diameter or more, oval or

2) outflow to the root, lymphangitis, which is defined as linear strands

3) at the root - enlarged infiltrated lymph nodes. Root

Fig 2. The outbreak of Gona

Rice. 3. CT scan calcinate in the lymph node of the mediastinum

In cases where the primary complex is detected in a timely manner and

decrease, and a symptom of "bipolarity" appears: clearly

2. Complications associated with the glandular component:

▪ Fig. 5. Thin-walled cavity (1), formed as a result of

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