195. Primary tuberculosis complex in the lung and its complications.

The morphological expression of primary tuberculosis is the primary tuberculosis complex. It consists of three components: the lesion in the organ — primary affect, tuberculous inflammation of the diverting lymphatic vessels — lymphangiitis and tuberculous inflammation of the regional lymph nodes — lymphadenitis.

In aerogenic infection, the primary tuberculous focus (affect) in the lungs is located subpleurally in the well-aerated III, VIII, IX, X (especially often in the III) segment, more often the right lung. It has the appearance of a focus of exudative inflammation, and the exudate quickly undergoes necrosis, a focus of caseous pneumonia is formed, surrounded by a zone of perifocal inflammation. The dimensions of the affect are different.

Very quickly, inflammation spreads to the lymphatic vessels adjacent to the primary focus — tuberculous lymphangiitis occurs with lymphostasis and the formation of tuberculous tubercles along the course of lymphatic vessels in the edematous perivascular tissue. A pathway is formed from the primary focus to the basal lymph nodes. In the future, inflammation quickly passes to bronchopulmonary, bronchial and bifurcation lymph nodes. They develop a specific inflammation with rapidly advancing caseous necrosis — total caseous tuberculous lymphadenitis. The lymph nodes increase several times and are filled with caseous masses on the incision. Changes in the regional lymph nodes are always more significant compared to the primary affect.

Further, there are 3 possible variants of the course of primary tuberculosis:

– attenuation of primary tuberculosis and healing of foci of the primary complex;

– progression of primary tuberculosis with generalization of the process;

– chronic course (chronically ongoing primary tuberculosis).

Complications:

Bronchial tuberculosis, bronchogenic lesions, pleurisy, formation of primary cavities and tuberculomas, meningitis, caseous pneumonia, bronchogenic, lymphogenic, hematogenic dissemination.

196. Forms of hematogenous generalized tuberculosis and their morphological characteristics.

Generalized hematogenous tuberculosis is the most severe form of the disease with a uniform rash of tuberculous tubercles and foci in many organs, it is extremely rare.

There are 3 forms:

Acute tuberculous sepsis

Acute general miliary tuberculosis

Acute common large-focal tuberculosis

Acute tuberculous sepsis. It is characterized by an extremely malignant course and fatal outcome in the first 2-3 weeks of the disease. It is characterized by high body temperature, dyspeptic disorders and erased cerebral symptoms. Radiologically, only the strengthening of the pulmonary pattern is determined in the lungs. MBT is not found in sputum. A negative reaction to Rob Mantoux is characteristic - passive anergy. On autopsy, necrotic foci are found in internal organs without signs of specific inflammation and proliferation, MBT is found in smears from necrosis foci.

Acute general miliary tuberculosis is characterized by a uniform dense rash of small, millet-sized tuberculous tubercles in the lungs.

Pathomorphology:

It is characterized by damage to capillaries and small veins with the formation of productive, less often exudative tubercles along the vessels

The tubercles have a similar structure due to the simultaneous formation of them

Acute microcirculatory dystrophic changes develop in the lungs

The lungs are more often affected throughout

Finally, usually in weakened patients, acute general large-focal tuberculosis is observed, which is characterized by the formation of large (up to 1 cm in diameter) tuberculous foci in various organs.

In each case of generalized hematogenous tuberculosis, it is necessary to find a source of contamination. They usually turn out to be an incompletely healed focus of primary infection in the lymph node, genitals, bone system, etc.