LECTURE THEME:
"PRIMARY TUBERCULOSIS.
PATHOGENESIS, CLINIC, DIAGNOSIS. SMOOTH AND COMPLICATED COURSE.
FEATURES OF THE COURSE OF
TUBERCULOSIS.
Lecturer: Dr. I. Y. Babaeva.
Teenagers should be examined by radiological examination in the following cases:
1.Any visit to a doctor if an fluorography has not been carried out in the current year.
2.When visiting a doctor with symptoms that suggest tuberculosis (prolonged lung disease (more than 14 days), exudative pleurisy, subacute and chronic lymphadenitis, erythema nodosum, chronic eye disease, urinary tract disease, etc.).
3.Before prescribing physiotherapy.
4.Before prescribing corticosteroid therapy.
5.Frequently and persistently ill adolescents shall be examined during an exacerbation period, regardless of the duration of previous therapy.
Suspicion of tuberculosis in a child should arise in the following cases (F. Miller, 1984):
1.Cessation of weight gain, gradual weight loss, apathy over 2 to 3 months; sometimes intermittent fever.
2.Sudden increase in body temperature (fever can last up to 3 weeks), sometimes combined with erythema nodosum or tuberculosis-allergic
(phlecenulosis) conjunctivitis.
3.Cessation of weight gain in the child combined with difficult wheezing and sometimes a persistent cough.
4.Sudden fever with pleural pain and effusion.
Suspicion of tuberculosis in a child should arise in the following cases (F. Miller, 1984):
5.Abdominal bloating and ascites.
6.Dense and painful masses in the abdomen.
7.Limp and painful swelling of large joints.
8.Difficulty in bending over, stiffness and soreness of the back, and possible deformity and shingling of the back.
9.Painless enlargement of peripheral lymph nodes surrounded by smaller lymph nodes.
Suspicion of tuberculosis in a child should arise in the following cases (F. Miller, 1984):
10.Any abscess localised in a peripheral lymph node, especially one that has developed gradually.
11.Subcutaneous abscesses or skin ulcers with no apparent cause.
12.Sudden and unexplained change in the child's mood, accompanied by a rise in body temperature, sometimes nausea and headaches.
13.Weight loss and apathy in older children and adolescents, combined with a productive cough.
Suspicion of tuberculosis in a child should arise in the following cases (F. Miller, 1984):
14.Prolonged recovery from measles, whooping cough, streptococcal tonsillitis or other intercurrent infection.
15.Signs of a diffuse intracranial process or diffuse encephalitis in children.
16.Painless haematuria or sterile pyuria in a child.
THERE ARE THREE MAIN FORMS OF
PRIMARY TB:
SMALL FORM.
TUBERCULES INTOXICATION (dolocal):
Clinically, a distinction is made:
•early;
•late.
TUBERCULES OF VOLUME (local):
•infiltrative;
•thrombotic.
TUBERCULSIS FIRST COMPLEX (local).
SIGNS OF TUBERCULOSIS INTOXICATION:
1."Virage'.
2.Micropolyadenopathy.
3.Intoxication syndrome prevails.
4.Radiologically, normal pulmonary pattern.
X-ray diagnosis of tuberculosis Intrathoracic Lymph Nodes
The infiltrative form of TUBERCULES OF EXTERNAL LYMPHATIC TUBERCULES is characterised by a root of lung infiltration syndrome on the radiograph:
The root shadow is enlarged in size (width) and/or length;
Outer contour of the root shadow is blurred; structure of the root shadow - disturbed (blurred); intensity of the root shadow - increased;
projection of the lumen of the intermediate or interlobular bronchus - partially obscured or absent.
X-ray diagnosis of infrathoracic lymph node tuberculosis
The tuberculosis of the intrathoracic lymph nodes is characterised by the presence of a polycyclic pulmonary root syndrome on the radiograph:
•This syndrome has all the hallmarks of a pulmonary root infiltration syndrome, but the outer contour of the shadow is clear, wavy (polycircular);
•Enlarged paratracheal, tracheobronchial lymph node groups are seen on the radiograph as semicircular shadows in the upper mediastinum.