LECTURE TOPIC:
«PRINCIPLES AND CHARACTERISTICS OF DIFFERENTIAL DIAGNOSIS OF TUBERCULOSIS AND OTHER RESPIRATORY DISEASES. PRIMARY TUBERCULOSIS (LOCAL AND LOCAL FORMS), DIFFERENTIAL DIAGNOSTICS WITH OTHER BREATHING DISEASES»
Lecturer: M.D. Babayeva I. Y.
THE LIKELIHOOD OF ILLNESS INCREASES
IN THE FOLLOWING SITUATIONS
•In the first years after infection.
•During puberty.
•In case of reinfection with MBT (exogenous superinfection).
•In the presence of HIV infection (up to 8 - 10% per year).
•In the presence of concomitant diseases (diabetes, FMD and duodenal ulcers, pregnancy, alcoholism).
•During therapy with glucocorticoids and immunosuppressants.
Tuberculosis in infants is detected mainly through public health services
The most common diagnosis is pneumonia, ineffectiveness of nonspecific AB therapyIneffectiveness of nonspecific AB therapy forces diagnosis with tuberculosis). In children infected with tuberculosis at the age under 1 year tuberculosis contact is detected in 100% of cases, from 1 up to 3 years old - in 70-80% of cases; 2/3 of infants with tuberculos is suffering from tuberculosis have not been vaccinated from tuberculosis have not received BCG or do not have a post-vaccination marker.
The most frequent complications are: bronchopulmonary lesions, hematogenous dissemination to the lungs andcerebral
membranes, decay of lung tissue.
Late diagnosis and progressive courselead to fatal outcome.
THREE MAIN GROUPS OF FACTORS,THAT DETERMINE AN INCREASEDTHREE MAIN GROUPS OF FACTORS DETERMINE AN INCREASED RISK OF TUBERCULOSIS:
1.Close contact with TB patients(domestic or occupational).
2.Various diseases and conditions,which reduce the body's resistance andCreating conditions for the development of tuberculosis.
3.Socio-economic, domestic,environmental, industrial and otherfactors.
STAGES OF INTERACTION BETWEEN MBT
AND MACROORGANISM:
1. The first is characterized by progressive MBT multiplication in the absence of specific response of T-lymphocytes and Lasts for two to three weeks.
2. The second occurs after the formation of mature T-lymphocytes and is characterized by MBT growth stabilization.
As a rule, this is followed by a stage of decompensation, which coincides with destructurization of lymphoid masses and the appearance of necrotic changes in the lungs. The vaccine effect can be is due to the shortening of the first phase process.
After infiltration of MBT into the lungsthe situation can evolve according to
4 basic schemes:
1.The primary host response may be sufficient for complete elimination of all MBT, the by eliminating the possibility of disease tuberculosis.
2.In the case of rapid growth and multiplication of MBTA disease known as primary tuberculosis.
3.In latent infection the disease does not develop, but the MBs persist in the body in a so-called dormant state, and their presence is manifested only in the form of positive skin reaction to tuberculin.
4.In some cases, MBT are capable to pass from dormant state into the growth phase, and the latent infection is followed by reactivation of tuberculosis.
PATOGENESIS
- In the development of tuberculosis it is possible to distinguish two periods, which are clearly distinguished by the character of immunological, morphological and clinical manifestations.
- The reaction of the body to the primary infection is defined as primary tuberculosis, and reaction caused by secondary infection (exogenous superinfection) or reactivation of old tuberculosis changes (endogenous reactivation) is defined as secondary tuberculosis.
Adolescents should be examined with
X-rays in the following cases:
1.At any visit to the physician, if FG has not been performed in the current year.
2.When you go to the doctor with symptoms that suspicion of tuberculosis (lung diseases with a prolonged course (more than 14 days),exudative pleurisy, subacute and chronic lymphadenitis, erythema nodosa, chronic diseases of the eyes, urinary tract, etc.).
3.Before prescription of physiotherapeutic treatment.
4.Before prescription of corticosteroid therapy.
5.Frequently and long-term ill adolescents are examined during an exacerbation, regardless of the timing of previous therapy.
Suspicion of child’s tuberculosis should be suspected of tuberculosis in the following cases
(F. Miller, 1984):
1.Cessation of weight gain, gradual weight loss, apathy for 2 to 3 months; sometimes intermittent fever.
2.Sudden increase in body temperature (the establishing fever may last up to 33), sometimes in conjunction with erythema nodosumor tuberculosis-allergic (phlecenulosis) conjunctivitis.
3.Cessation of weight gain of the child in a combination of hoarse, labored breathing and, occasionally, a persistent cough, sometimes a persistent cough.
4.Sudden fever with pleural pain and effusion.
Suspicion of child’s tuberculosis should be suspected of tuberculosis in the following cases (F. Miller, 1984):
5.Abdominal bloating and ascites.
6.Dense and painful masses in theabdomen.
7.Limp and painful swelling in theThe area of the large joints.
8.Difficulty in bending over, stiffness andBack painfulness, possible backdeformity and shingling pain.
9.Painless enlargement of peripherallymph nodes surrounded by moresmaller lymph nodes.