Timely detected forms

ofBytuberculosis
Makarova Elena Alexandrovna
Timely detected forms of tuberculosis

 It is early restricted processes of specific inflammation with

localization in no more than 2 segments on one side without
distraction of the lung tissue.
 Patients with timely detected forms of tuberculosis should be
the main group taken on dispansery registration for the first
time .
Timely detected forms of tuberculosis include:

 tuberculosis of the intrathoracic lymph nodes in the infiltration

phase
 primary tuberculosis complex in the infiltration phase
 focal pulmonary tuberculosis in the infiltration phase
 restricted infiltrative pulmonary tuberculosis and disseminated
pulmonary tuberculosis in the infiltration phase
 tuberculous pleurisy
Timely detected forms of tuberculosis

 The proportion of such forms of tuberculosis reaches 70-80%

in case of well organized work on TB revealing and the
epidemiological situation of tuberculosis in territory is
favorable.
 The treatment is usually successful, and relapses are rare.
Focal tuberculosis
Focal pulmonary
tuberculosis– it is a site of
specific inflammation, no more
than 10-12 mm in diameter, with
localization no more than in two
segments on one side.
EPIDEMIOLOGY OF TUBERCULOSIS

Focal pulmonary tuberculosis makes about 50% of

all newly revealed tubercular forms.
The most frequent localization – I, II, VI
segments of the lungs.
It's connected with:
1. Narrowness and length of the upper lobe bronchus.
2. Limited excursion of the upper parts of the lungs, which creates
conditions for the formation of mucous plugs and their infection.
3. Slowing down in the upper parts of the lymph flow.
4. Reduced blood flow in the upper lungs due to the orthostatic
position of the body and the suction effect of the diaphragm.
5. The upper parts of the lungs are zones of hypersensitization, in
which MBT is selectively fixed.
Types of foci according to size

 Small – 2-3 mm
 Medium – 4-6 mm
 Large – 7-10 mm
Types of foci according to genesis

 Primary Genesis:
Due to early lymphohematogenic generalization of the
tuberculosis process from the intrathoracic lymph nodes, in which
bronchogenic and lymphogenic dropouts are formed. There is a
rapid regression of changes. In 50% of patients, complete
resorption of changes is noted, in the rest there is a small fibrosis,
single dense foci.
 Secondary Genesis:

Focal tuberculosis
Simon's foci – residual changes in focal
tuberculosis of primary genesis

 They have the appearance of a uniform shadow with a clear

rounded or oval shape with the inclusion of calcium salts.
 Located either symmetrically in the apices (hematogenic), or
in the basal area (lymphogenic), or in places typical for
bronchogenic spreading (II-IV segments).
Aschoff-Pul's foci are characterised by fibrotic-foci
as the resalt of any form of tuberculosis
 Secondary Genesis.
 Larger sizes, mainly in the posterior parts of 1-2 segments.
 They occur when non-resolved foci are replaced with
connective tissue, turning into scars, and peribronchial and
perivascular sclerosis is formed along the lymphatic
pathways.
 A fibrous or hyalinized capsule is formed often around
caseous foci.
PATH0M0RPH0L0GICAL CHARACTERISTICS

 The focus pulmonary tuberculosis referred to the

manifestation of secondary tuberculosis.
 It is the initial form of pulmonary tuberculosis in an adult.
 To this type of tuberculosis refer: fresh or soft focal
tuberculosis; fibrotic focal tuberculosis with foci of less than 1
cm in diameter.
PATH0M0RPH0L0GICAL CHARACTERISTICS
Soft focus pulmonary tuberculosis morphologically represented by the development of endo- and peribronchitis
of the fine apical branches (1-st and 2-nd order of the segmental bronchi).
There is subsequent caseous necrosis in the bronchi walls. The involvement of the nearby alveoli results in the
formation of caseous acinus or lobular bronchial pneumonia.
For a long period of time, the process within the lungs will be limited within the acini or lobules. As the process
progresses, new foci will appear near the original focus, developing by contact within the limits of the same lung
segment. Lymphostasis will develop in the lymphatic vessels, fibrotic tissue layers, peribronchial and perivascular
tissues, passing on the lung hilum.
The typical path of the lung focal tuberculosis progression is a bronchogenic progression.
New bronchial pneumonic foci will form from this progression. However damage of lymphnodes is not
characteristic.
At favorable course the bronchopneumonic focuses are exposed to encapsulation, calcification, fibrosis or
hyalinosis.
The focuses have character of latent development at the fibrotic focus pulmonary tuberculosis, but under
adverse conditions, their aggravation possible with exudative reactions and growth of a zone of necrosis.
PATHOGENESIS OF TUBERCULOSIS
 МВТ disseminate from foci along lymphatic pathways and fine bronchi.
 More often fresh foci appear in upper lobes of the lungs.
 At the beginning, hi the places where МВТ settled, endobronchitis
occurs.
 Then, the inflammation covers all fine branches of the bronchi. Caseous
necrosis develops in the damaged bronchi with the subse quent
transition into pulmonary tissue, more often to apical areas.
 The small focus develops as caseous, acinus or lobular pneumonia.
 Exudations are insignificant and are quickly replaced by productive
reaction.
PATHOGENESIS OF SECONDARY TUBERCULOSIS

 Focal tuberculosis can be derived from the action of the

primary or more often the secondary period of tuberculosis.
 The focal forms of secondary tuberculosis arise under the
influence of:
1. exogenous reinfection;
2. endogenic dissemination of МВТ, from previously latent
foci.
Focal pulmonary tuberculosis

• The course of this form can proceed without

subjective feeling
• Occasionally it is detected by screening fluorography.
• Subsequent medical examination, quite often reveals
that patients do not pay attention to symptoms, of
tubercular intoxication for rather long time
Forms of focal tuberculosis

 acute soft focal tuberculosis

 chronic fibrous focal tuberculosis

In the process of healing of the different forms of

tuberculosis, residual foci are formed.
Important to remember

 Some patients who undergo fluorography which

revealed focus tuberculosis do not show any clinical
symptoms.
Diagnosis of tuberculosis

 Radiographic methods - characteristic radiological changes

 Laboratory methods - detection of MBT in the contents of the
bronchi, rarely in the sputum.
 Immunological methods - skin tests are usually moderately
expressed
 Endoscopic methods - during bronchoscopy getting of the
lavage fluid allows to receive a material for diagnosis
 A well-collected anamnesis and physical examination
 Clinical and radiological dissociation.
Symptoms of tuberculosis

 weakness, sweating, diminished work capacity and appetite

up to a year before observation;
 subfebrile temperature during the day;
 the unstable cough — dry or with poor amount of sputum;
 pains on the side of a chest are observed sometimes.
Physical examination

 weak pain is observed in the muscles of the humeral zone in

the affected area;
 shortening of percussion sounds can be found only when foci
of inflammation begin to merge;
 harsh breathing and rare fine moist rales can be heard in
acute phases of focal tuberculosis and in presence of
infiltrations.
Immunological methods

Skin tests are usually moderately expressed (positive and

hyperergic):
 Skin tuberculin test (Mantoux test) with 2 TU PPD-L;
 Skin test with ATR (Diaskintest).
Blood tests

Changes in the blood are not characteristic for this form of

disease, and depend on the phase of disease:
 in less severe expressed forms, blood is normal;
 during the phase of infiltration, ESR is a little bit elevated,
insignificant lymphopenia.
Laboratory methods

Detection of MBT in the contents of the bronchi, rarely in

the sputum.
 microscopy (methods of Ziehl – Neelsen, luminescent
microscopy);
 culture methods (culturing of mycobacteria in solid nutrient
media, BACTEC);
 new molecular biological methods of MBT identification
(polymerase chain reaction (PCR)
 drug susceptibility testing;
Radiographic methods

 Fluorography
 General view X-ray
 Lateral view X-ray
 Tomography – linear and computed
Radiographic methods

General view X-ray Computed tomography

Soft focal tuberculosis
Fibrotic focal tuberculosis
Radiological features of focal tuberculosis
 The foci could be solitary or multiple;
 More often localized in one lung;
 Mainly in the upper parts: in I, II and VI segments;
 Quite often merge among themselves;
 Around foci, wide linear forming net shadows, representing lymphangitis
are visible.
 When tuberculosis progresses the increase in quantity of the fresh foci,
in­tensification of lymphangitis are defined, accompanied with cavities of
distraction.
Endoscopic methods

 Tracheobronchoscopy with bronchoscopic lavage

During bronchoscopy getting of the lavage fluid allows to
receive a material for diagnosis for cytological verification for
the diagnosis of TB at negative bacteriological data.
Sometimes from the lavage waters, it is possible to reveal
MBT, when it is impossible to reveal by other ways
These methods of research are accessible in equipped,
specialized medical establishments staffed with the adequately
trained personnel.
Differential diagnosis

 non-specific pneumonia
 peripheral cancer
 benign tumor
 parasitic disease
Treatment of tuberculosis

 Chemotherapy is the main method of treatment;

Chemotherapy according to regime №III with changes after
receiving information about the drug sensitivity of MBT. In the
first two months it is performed in a hospital or day hospital,
then on an outpatient basis.
 Sanitary-hygienic regime and therapeutic nutrition;
 Pathogenical therapy- immunomodulators, antioxidants, anti-
inflammatory therapy, and others;
 Collapse therapy and surgical interventions - never use.
The standard chemotherapy regimes
Criteria of effectiveness in the treatment of
tuberculous

 The disappearance of clinical and laboratory signs of

tubercular inflammation
 The stable termination of MBT expectoration, confirmed by
microscopic and cultural examinations
 The regression of radiographic signs of tuberculosis (focal,
infiltrative, destructive)
 The restoration of functional and work capacity