Focal pulmonary tuberculosis: features and treatment. Focal pulmonary tuberculosis

Tuberculosis is a chronic, epidemically dangerous infection. Even despite the measures taken, the incidence of the disease is not decreasing. The focus of pulmonary tuberculosis means either the place of residence of a large number of patients with this disease, or the place where the disease is localized in the tissues of the body. The classification of tuberculosis foci is based on an analysis of the patient’s living conditions, social status, how the tuberculosis foci is subjected to anti-epidemic measures, etc.

In total, there are 5 foci of tuberculosis. Epidemic foci of tuberculosis vary from the most dangerous to the potential. The most dangerous focus of pulmonary tuberculosis with bacterial excretion is in unfavorable living conditions with children and adolescents. A potential group of tuberculosis foci is when the source of infection is a sick animal. Epidemic foci of tuberculosis should be subjected to examination, dynamic observation and disinfection. The focus of pulmonary tuberculosis is the most common and dangerous case of tuberculosis. Tuberculosis, the lesion located in the lung tissue, is most easily diagnosed using fluorography, radiography and CT. Examination of the focus of tuberculosis in other organs and systems is carried out by highly specialized specialists (for example, in the presence of intestinal tuberculosis - a gastroenterologist).

Localization of tuberculosis in the body

The Koch bacterium is capable of penetrating any tissue of the human body and forming specific granulomas there. The respiratory system is most often affected by tuberculosis infection.

There are pulmonary tuberculosis, tuberculosis of other organs and systems, as well as tuberculosis intoxication in children and adolescents.

Photo 1. Mycobacteria

When the lung tissue is affected, a primary focus is formed, which subsequently leads to specific damage to local lymph nodes, the development of tuberculous lymphadenitis, and blood vessels (lymphangitis). This can lead to the spread of the process to the bronchial, tracheobronchial and mediastinal lymph nodes, i.e. to the development of bronchoadenitis. It belongs to minor forms of tuberculosis.

Pulmonary forms:

• focal tuberculosis, localized within several segments. Its occurrence is caused by reactivation of foci. In this case, inflammation is limited and therefore gives a rather poor clinical picture.
• infiltrative, when lung tissue is replaced by fibrous tissue, the lesions are encapsulated. This represents a kind of healing;
• disseminated - with the formation of many foci in the lungs and their spread to other organs by lymphogenous, hematogenous and bronchogenic routes. The outbreak looks like millet - small light tubercles. The fact that this type of tuberculosis has arisen in the body can be judged by an x-ray. On it you can see many small lesions, the size of which is no more than a couple of millimeters.

Photo 2. Fresh lesion in the lungs

Tuberculous pleurisy may occur under the pleura. Either independently or from the primary focus. Of the post-tuberculosis complications in the pulmonary form, adhesions occur mainly.

Extrapulmonary tuberculosis can occur:

• on the skin and subcutaneous fat. The process manifests itself in the formation of subcutaneous nodules, which, as the process progresses, open.
• when tuberculosis infection is localized in the joints, clinical arthritis appears, in the bones - pain, frequent fractures;
• damage to the gastrointestinal tract is manifested by dyspeptic symptoms (abdominal pain, flatulence, nausea, diarrhea), the progression of the process can lead to the formation of intestinal obstruction.
• Tuberculosis of the genitourinary system may have symptoms of nephritis, pyelonephritis, cystitis. Complications can vary in severity, including infertility.
• Damage to the meninges and central nervous system develops rapidly. For several weeks, sleep disturbances, irritability, headaches are observed, then uncontrollable vomiting, convulsions and other disorders appear.
• tuberculosis of the organ of vision manifests itself as the formation of a caseous focus in the conjunctiva, iris or sclera. Usually the process spreads to deeper tissues and leads to blindness.

Photo 3. Tuberculosis of the visual organs leads to blindness

There are secondary tuberculosis. It occurs in weakened organisms (in immunodeficiency states): infection is activated in old foci. Most often, Simon's lesion leads to its occurrence - these are group deposits of Koch bacilli remaining after primary tuberculosis intoxication.

Types of tuberculosis foci

The focus of tuberculosis infection is a limited territory in which a patient with tuberculosis, the people around him, and objects of the external environment currently reside. The source of infection is an imprecise concept, because in addition to the permanent place of residence of the patient and his relatives, it includes:

• place of work/study of the patient and relatives who are constantly in contact;
• the patient’s social circle (colleagues, friends, neighbors, relatives);
• the hospital where the patient is hospitalized;
• if the place of residence is a village or town, then its entire territory becomes a hotbed of tuberculosis infection.

Photo 4. The source of infection can be a group of people

Whether a tuberculosis outbreak belongs to one group or another is determined by the local phthisiatrician with the obligatory participation of an epidemiologist. This order is maintained when the outbreak is transferred from one epidemic group to another in the event of a change in conditions in the outbreak that increase or decrease the risk of infection or disease.

Depending on the risk of new cases of infection, 5 groups of outbreaks are distinguished. To determine the degree of danger, the following characteristics are used:

• social status, intellectual level of the patient, level of literacy and culture;
• characteristics of housing and communal conditions: type of housing (communal apartment, dormitory, own apartment or house), compliance of its area with the norm, availability of amenities (toilet, bathroom, electricity, gas, heating, water), etc.;
• quality of implementation of anti-epidemic measures;
• presence among contact children, adolescents, pregnant women and the elderly;
• localization of tuberculosis infection;
• resistance of mycobacteria to therapy, their number.

Photo 5. Morbidity depends on social status

The groups range from TB foci with the highest risk of infection to those with minimal risk.

Index	Group I	Group II	III group	IV group
Massiveness of MBT excreted by patients	chronic destructive tuberculosis, the patient constantly excretes the tuberculosis bacillus	scant bacterial excretion in stable tuberculosis process	form of active tuberculosis without MBT isolation	the patient is a conditional bacteria excretor
Patient's environment	there are children, teenagers or pregnant women in the family	There are adults in the family, no children or people at risk	there are children or teenagers in the family	only adults in the family
Housing conditions and hygiene culture	poor living conditions, lack of hygiene		acceptable living conditions, generally hygiene is observed	all sanitary and hygienic requirements are met

The table shows the classification of tuberculosis foci according to their main indicators.

Methods for studying foci of tuberculosis

The primary examination can be carried out by mid-level medical workers working in a hospital, outpatient clinic, dispensary or health care organization, as well as doctors of any profile.

Within the medical institution, signs indicating possible tuberculosis are identified. The phthisiatrician confirms the diagnosis or refutes it.

Photo 6. Phthisiatrician

During the examination, anamnesis plays an important role. During the conversation with the patient it becomes clear:

• complaints: sudden weight loss recently, loss of appetite, persistent cough that gets worse at night (especially if it lasts more than 2-3 weeks);
• a history of respiratory system diseases;
• the presence in the family of people suffering from tuberculosis of any form;
• social well-being of the family: living conditions, availability of a permanent job, number of family members (especially children).

In the process of communicating with the patient, you can determine the level of his culture and intellectual abilities.

Photo 7. Cough is a symptom of pneumonia

Three main methods are used to detect Mycobacterium tuberculosis in the body:

• tuberculin diagnostics;
• bacteriological research.
• X-ray examination.

Tuberculin diagnostics is carried out in two ways:

• Mantoux test - for children aged 1 to 14 years inclusive, once a year;
• Diaskintest - children 8 to 17 years old inclusive, once a year. This test is carried out in the same way as the Mantoux test - 0.1 ml of the drug is injected intradermally into the middle third of the forearm. The result is assessed after 3 days (72 hours).

Photo 8. Diaskintest allows you to identify focal tuberculosis

A papule measuring 2 mm or more indicates an inflammatory process.

Bacteriological testing involves analyzing sputum to detect Mycobacterium tuberculosis. When collecting material, you should follow the rules of personal hygiene. Before and after coughing, you need to rinse your mouth. Sputum must be coughed up, not expectorated. The collection is carried out for 1-3 days in a dark glass spittoon; it is stored in a dark, cool place.

X-ray examination includes fluorography and radiography.

Fluorography is carried out for all citizens once a year, twice a year it is required to be carried out by workers in the food industry, medical workers, educators and teachers in kindergartens and preschool educational institutions. This is a procedure included in the mandatory medical examination.

Radiography is performed when darkening is detected on the fluorogram to clarify the diagnosis.

Computed tomography of the lungs is now preferred to radiography. It allows you to determine the size of the process and the pathomorphological picture as a whole.

Photo 9. Fluorography to identify the pathomorphological picture

To diagnose tuberculous lymphadenitis, lymphangitis and bronchoadenitis, a biopsy of the lymph nodes is performed. To identify tuberculosis of the meninges and the central nervous system, it is necessary to consult a neurologist, conduct an EEG, MRI, CT scan of the brain and spinal cord, as well as perform a spinal puncture with Koch's bacillus culture.

If gastrointestinal tuberculosis is suspected, consult a gastroenterologist, FGDS, ultrasound.

Preventing the spread of disease in the body

Preventing the spread of tuberculosis infection to other tissues and organs lies primarily in timely and correct treatment. The earlier therapy is started, the higher the percentage of favorable outcome. The course of treatment lasts about 12 months (in a hospital, sanatorium-resort), a complex of drugs is prescribed, the effect of which is aimed at healing the lesions. 2-4 drugs are prescribed, for example rifadin in combination with isoniazid, as well as ethambutamol.

Photo 10. Treatment with medications

If conservative methods are not effective, resection of the affected organ is performed.

The best treatment is for a fresh lesion, the formation of which is characterized by acute focal tuberculosis.

It is important to discuss personal transmission control measures with patients, such as covering their mouth and nose with a tissue when coughing or sneezing. It is necessary to explain to the patient and his family members that ventilation and good ventilation remove droplets from the air in the room, and direct sunlight quickly kills MBT.

An active lifestyle plays an important role in preventing the spread of the disease: walks in the fresh air, physical exercise, relaxation in the Crimea, as well as high-calorie nutrition and consumption of large amounts of vitamins.

Video: Foci of tuberculosis spread

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Focal pulmonary tuberculosis develops against the background of primary sources of the disease that were previously cured. The disease can be asymptomatic and diagnosed during a fluorographic examination.

Pathology occurs in 2 forms:

• soft focal;
• chronic fibrous focal tuberculosis.

During the healing of various forms of pathology, focal shadows are formed. The causative agents of the disease are mycobacteria of the genus Mycobacterium. The main characteristic of MBT is considered to be pathogenicity, manifested in virulence. The value of the last indicator changes taking into account environmental factors. MBT are prokaryotes whose plasma lacks lysosomes, capsules and microspores. A bacterial cell consists of a microcapsule, a cell wall and a membrane.

Before treating the disease, it is necessary to find out what focal pulmonary tuberculosis is and how it is transmitted. This pathology is characterized by the development of an inflammatory process that promotes the formation of various tubercles.

The pathogenesis of the disease is diverse and complex. This form manifests itself in the form of a primary or secondary period of tuberculosis. Secondary focal shadows are observed in adults. They include caseosis and MVT.

With an exacerbation of the process, MVT from the foci spreads through the bronchi and lymph nodes. More often, new lesions are diagnosed in the upper part of the lungs. Endobronchitis first develops, then small branches of the bronchi are affected. Inflammation spreads to the lung tissue, contributing to the formation of a small focus (lobular, or acinar, pneumonia).

The possibility of infection depends on the time of contact with the patient. The risk of developing an active form of the disease increases in the case of constant and close contact with a carrier of tuberculosis. A person at risk must take special anti-tuberculosis drugs (minimum dosage). The prognosis of the disease depends on the stage and compliance (during treatment) with the doctor’s recommendations.

Secondary focal pulmonary tuberculosis is divided into 2 forms:

1. The fibrous-focal form promotes the formation of dense sources and scar tissue. There is no inflammatory process. This form of the disease is characterized by symptoms such as deposition of calcium salts and hardening of tissues.
2. Soft-focal easily breaks up into cavities. Timely treatment of focal tuberculosis is aimed at resolving cavities and eliminating the inflammatory process. If the disease is diagnosed in the thickening phase, thickened areas may remain. Pieces of tissue are effectively eliminated by the lungs and bronchioles. Instead of sealing areas, a decay cavity remains.

Doctors include the following as consequences of pathology:

• a favorable outcome if correct and timely treatment is prescribed;
• relatively favorable prognosis - calcifications and fibrosis remain, while the pathology is cured;
• death is possible if the disease is severe.

In patients with focal pulmonary tuberculosis detected by fluorography, clinical symptoms do not appear. With the development of low-spread focal tuberculosis, the patient experiences mild weakness, sweating, poor appetite, and low ability to work. The patient complains of the following symptoms:

• heat in palms and cheeks;
• short-term chills;
• slight low-grade fever;
• a cough rarely appears, dry or with sputum;
• pain in the side.

To make an accurate diagnosis, the doctor examines the patient. If the disease has entered the infiltration phase, then the patient is diagnosed with:

• slight soreness of the shoulder muscles;
• immutability of lymph nodes;
• hard breathing;
• wheezing;
• moderate tuberculin tests.

Changes in the blood are observed taking into account the phase of the disease. If the pathology is diagnosed in the early stages, then the blood counts are normal. In the infiltration phase, ESR increases. The chronic course of the process is characterized by a productive form. On CT, the doctor identifies small and medium-sized lesions (size 3-6 mm). They can be round or irregular in shape with medium to sharp intensity.

Using an x-ray, lesions with a diameter of 1 cm can be identified. Their outline can be clear or blurred, intensely weak or medium. Multiple and single lesions are located in the 1st lung. As the disease progresses, the number of lesions increases. Decay cavities may appear.

Timely treatment of the disease in the first stages is aimed at resolving the lesions within 12 months. Upon completion of therapy, an x-ray is taken. If the treatment regimen is chosen correctly, the doctor will see complete recovery of the lungs in the pictures. Rarely, after a course of therapy, gross fibrosis develops instead of fresh lesions.

Focal tuberculosis in the infiltration phase is treated in a hospital. The patient is prescribed 1st line tuberculostatic drugs. Treatment is stopped after complete regression of infiltrative changes in the lungs. On average, the course lasts 9 months. Anti-relapse therapy is carried out in a dispensary. If there is no long-term effect, artificial pneumothorax or surgery is possible.

Drug treatment of focal tuberculosis involves the use of the following drugs:

1. Tubazid - has antibacterial and bactericidal effects. The dosage is selected by the doctor in each case individually. The drug is available in the form of tablets, powder (for preparing the medicine) and ampoules (ready-made 10% solution).
2. Isoniazid - if the drug is poorly tolerated, then Ftivazid is prescribed.
3. Rifampicin is a semisynthetic broad-spectrum antibiotic. It is taken orally on an empty stomach. The drug is recommended to be used in combination with anti-tuberculosis drugs (Ethambutol).
4. Streptomycin is prescribed at the initial stage of therapy. The course of treatment lasts 2-3 months. The drug is taken every day or 2 times a week (aerosol or intramuscular). If the drug is poorly tolerated, it is administered in 2 doses. Duration of therapy is 3 months.
5. Ethambutol is an anti-tuberculosis bacteriostatic agent (antibiotic). Taken orally. The dosage of the drug depends on the patient’s body weight. Prescribed at the 2nd stage of therapy orally (every day) or 2 times a week.
6. Ethionamide is a synthetic anti-tuberculosis drug. It is taken orally after meals (once a day). If the drug is well tolerated and the patient’s body weight exceeds 60 kg, then the medicine is taken 4 times a day.

Focal pulmonary tuberculosis is a social disease that occurs due to poor living conditions. The disease is more often diagnosed in men than in women. In this case, persons aged 20-39 years are affected.

Prevention of the disease consists of carrying out anti-epidemic measures:

• Mantoux test;
• fluorography.

It is definitely recommended to conduct periodic inspections of people living in unfavorable conditions. Children are at risk (because they have an unformed or weak immune system). If a family member has tuberculosis, it is necessary to limit the baby’s contact with him. In this case, the child is registered with a TB specialist.

If the infection is not detected or is primary in nature, the child does not pose a threat to others. He can attend kindergarten and school. If necessary, the baby is recommended to prevent pathology.

If Koch's bacillus enters the body of a pregnant woman, the same studies are indicated as for a normal patient (except for a chest x-ray). Due to contact with an infected person, pregnancy is not interrupted. But a pregnant woman must observe the following precautions:

• use of a medical mask;
• using a hair scarf;
• wearing clothing made from materials that are resistant to disinfectant.

Newborn children receive primary vaccination within 30 days.

Collapse

Under the influence of certain factors, focal pulmonary tuberculosis may develop. It is usually asymptomatic and rarely accompanied by mild symptoms. The most effective diagnosis is using x-ray methods. The treatment regimen usually includes taking 4 special anti-tuberculosis drugs, but in some cases surgical intervention is required.

What kind of disease is this?

Focal pulmonary tuberculosis is a disease in which several small pathological foci appear in the lungs. Usually the inflammation does not spread to the entire lungs, but only to 1-2 segments.

It is a secondary infection. In most cases, it occurs a long time after recovery from the primary disease. Therefore, people over 35 years of age are mostly affected. Pathology is observed in 15-20% of all cases of pulmonary tuberculosis. ICD 10 code is A-15.

Most often, focal tuberculosis of the upper lobe of the right lung is observed. This is due to the fact that this area is immobile, poorly oxygenated, and characterized by weak blood and lymph flow.

Is this type of tuberculosis contagious or not? Infection can occur, but only with prolonged contact with an infected person. Is it contagious to others? Yes, but only with an active form. Usually in this case, the doctor recommends treatment in a hospital.

Causes

The following routes of infection are distinguished: exogenous or endogenous. In the first case, the infection enters the human body from the outside. This may happen if:

• A person has been in contact for a long time with a patient with focal tuberculosis. For example, if there is an infected person in the family. During short conversations and other contacts, infection does not occur.
• The same dishes, personal hygiene items and clothing are used with the patient.
• In a house where there is an infected person, sanitary standards are poorly observed and cleaning is not carried out.
• After the death of a sick person, the apartment was not disinfected, but they continue to live like this. The mycobacterium that causes tuberculosis is very resistant and does not die even in an acidic environment. Therefore, without thorough disinfection and cleaning of the room, there is a chance of getting sick.

The focal form of tuberculosis is transmitted mainly through the air. After infection occurs, the sick person begins to secrete the same mycobacteria as the person from whom the infection occurred.

The disease may have another pathogenesis. In the case of endogenous development, the previously existing infection becomes active again. That is, inflammation begins in old foci of the disease. Reactivation of the infection is typical not only for the lungs, but also for the intrathoracic lymph nodes. This usually occurs as a result of decreased immunity. This can happen due to frequent stress, poor diet, and excessive use of medications.

Groups and risk factors

A number of factors contribute to the development of secondary tuberculosis. These include:

• acute and chronic pathologies of the respiratory system;
• any diseases of the body that lead to a decrease in immunity;
• taking immunosuppressants, which are necessary to artificially suppress the immune system;
• stomach ulcer, diabetes mellitus;
• presence of bad habits;
• an overly active lifestyle leading to frequent overwork.

The risk group includes people who are often in the same room with infected people - family members, employees of TB dispensaries and prisons. In addition, the disease can appear in those who have previously suffered any form of pulmonary tuberculosis.

Classification

The disease can be classified according to several criteria. Let's consider each case separately.

According to the duration of the course

Foci of tuberculosis in the lungs are divided into:

• Fresh, or soft-focal. They appear as a result of endogenous factors. That is, they arise from a previously existing primary infection, which was inactive for a long time.
• Chronic, or fibrous-focal. This pathology may result from the disintegration of fresh lesions. But often it occurs due to the resorption of other forms of primary pulmonary tuberculosis. Usually the lesions are quite large, placed in a fibrous capsule. Sometimes calcification occurs in them - the accumulation of calcium salts (lime), which enters the body with water and food. In most cases they are harmless and are residual lesions. But if the capsule ruptures, the disease may return. In this case, the boundaries of the lesion may increase several times.

Both forms of the disease must be treated urgently. Otherwise, the pathological process may spread, leading to serious complications. Fatal cases are very rare, but have still been recorded.

By phase

There are 3 main phases of focal tuberculosis. Each of them has its own characteristics and degree of danger to the body:

1. Focal tuberculosis in the infiltration phase. During it, exudate accumulates around the lesion. If the infiltrate is spherical, but without clear boundaries, then the inflammatory process is fresh. When the infiltrate is cloud-like and occupies one or more lobes of the lung, we are talking about a chronic process. In the second case, a fibrous capsule is formed, and the inside of the formation is filled with caseosis - necrotic fibers.
2. Tuberculosis in the decay phase. This phase is characteristic of the fibrous-focal form of the disease. The fibrous capsule is destroyed, and its contents enter healthy lung tissue. This condition is very dangerous for human health. If the pathology is not diagnosed in time, there is a risk of damage to several segments of the organ. The pathological process is accompanied by intoxication of the body, increased fatigue and respiratory failure.
3. The disease is in the compaction phase. With proper treatment, bacterial excretion disappears. The source of the disease begins to resolve. Caseous compaction is observed due to the deposition of calcium salts. The inflammatory response decreases. If the patient had cavities, they heal, forming scars. On x-rays you can see a lesion that has a heterogeneous structure. It is usually round with uneven contours. It must be borne in mind that this phase does not mean complete recovery. There is a positive effect, but in order to maintain it, you must continue therapy and follow the recommendations of your doctor.

It usually takes at least a year for complete recovery. Resorption of the formation lasts up to 4-5 months. X-rays indicate that the patient has recovered - the lesion has either completely disappeared or parts of fibrous tissue remain.

By size

Depending on the diameter of the lesions, they can be of three types. Small (up to 3 mm) lesions quickly resolve with adequate therapy. Medium (up to 6 mm) can develop into a fibrous-focal form. Large lesions (more than 1 cm in diameter) are difficult to resolve, and such tuberculosis is accompanied by a severe course. Treatment may require surgery.

Symptoms and signs

As a rule, the focus of tuberculosis is small, rarely exceeding 1 cm in diameter, so the pathology is often asymptomatic. The clinical picture is blurred, symptoms are mild or completely absent.

However, in some cases the following symptoms may appear:

• Intoxication of the body. The patient complains of nausea, sometimes even vomiting. The state is depressed, there is increased fatigue.
• Low-grade fever – up to 37.5 degrees. It is usually observed in the evening hours.
• Signs of vegetative-vascular dystonia rarely occur. The patient may complain of severe headaches, excessive sweating in the evening, and insomnia.

Focal tuberculosis is rarely accompanied by cough, and especially by hemoptysis. Therefore, such a disease can go unnoticed for years, becoming chronic. It is usually discovered accidentally during routine fluorography.

During certain periods, the patient's condition improves. The low-grade fever disappears and he feels well. Typically, exacerbations occur in the fall or spring.

Diagnostics

Physical methods are ineffective in diagnosing focal tuberculosis. During palpation, the doctor can detect pain, which is usually localized over the area of ​​the inflammatory process. As a rule, enlargement of the lymph nodes does not occur. Upon percussion, it is discovered that the sound above the lesion is duller. Auscultation allows you to determine that there are noises during breathing, and loud wheezing is heard during coughing.

Tests with tuberculin cause a normergic reaction - minor changes in the affected area. Only sometimes the Mantoux test or Diaskintest can cause pronounced symptoms - severe swelling and redness in the injection area, increased body temperature, and the appearance of copious sputum. Sputum and bronchoalveolar lavages are also examined.

X-ray methods are considered the most accurate in making a diagnosis. But the picture may differ depending on the type and phase of the disease. If the pathology is fresh, several large and a couple of small lesions are detected on the x-ray. The shadows have a rounded shape, their outline is poorly distinguishable.

But the chronic form of the disease is characterized by compacted foci with a homogeneous structure. Shadows may be blurry or very distinct. As a rule, their size is small - from small to medium. A distinctive diagnosis must be carried out so as not to confuse the disease with other pathological conditions of the respiratory system.

If the picture is blurry and the doctor cannot make an accurate diagnosis, test therapy is prescribed. It consists of taking anti-tuberculosis drugs for several months. The doctor notes the presence or absence of dynamics. If the lesions begin to decrease, the diagnosis of tuberculosis is confirmed.

Treatment

Treatment of focal pulmonary tuberculosis is carried out with medication and surgery. Both methods are characterized by their own characteristics.

Drug therapy

In most cases, it is carried out in a hospital setting. If the disease has a closed form, treatment at home is allowed, but subject to regular visits to the local phthisiatrician. The first stage of chemotherapy involves taking 4 anti-tuberculosis drugs - Isoniazid, Ethambutol, Pyrazinamide, Rifampicin. The dosage is determined by the doctor. As a rule, the first stage lasts approximately 2-3 months.

Then, for another six months, only two drugs are prescribed, but one of them must be Isoniazid. Once every 4 months, the patient must undergo fluorography (usually not recommended, since X-rays are dangerous to the body) to monitor the dynamics of treatment.

In general, the duration of therapy is 6-9 months. Sometimes you may need to take medications for one year. After completion of treatment, a long period of rehabilitation is required. It is advisable that the patient undergo it in an anti-tuberculosis sanatorium.

Drug therapy is usually effective for any phase of the disease and size of the lesions. But sometimes it does not work, so surgery is required.

Operations

A lobectomy or segmentectomy is performed. In the first case, a lobe of the right or left lung is removed (depending on the location of the lesion). And the second option involves removing an entire segment - several lobes, if the pathological process has spread greatly.

Resection of the entire lung does not make sense, since in most cases more gentle methods are effective. After surgery, maintenance therapy is required.

Forecast

The outcome of treatment is often favorable and ends in recovery. Fresh lesions resolve faster than chronic ones. In the second case, there is a possibility that the disease will develop into another form.

Possible complications and consequences

If fresh lesions are not detected in time, there is a possibility of chronic disease. Fibrous focal tuberculosis can lead to pneumosclerosis - the formation of numerous fibrous or calcific foci. Such patients require a longer course of chemotherapy – sometimes up to 2 years.

Prevention

For preventive purposes, it is necessary to undergo regular X-ray examinations. You should boost your immunity by eating foods rich in vitamins. You can also purchase vitamin complexes in pharmacies. This will prevent not only tuberculosis, but also other diseases. It is very important to observe hygiene measures and use separate dishes, soap, towel, comb and other items.

Thus, focal tuberculosis is easily treatable. But it is almost asymptomatic, so there are difficulties in detecting it. And the sooner you start therapy, the higher the chances of a positive outcome.

Focal pulmonary tuberculosis is a clinical form of tuberculosis, which is a conventional collective clinical and morphological concept. It includes lesions of tuberculosis etiology that vary in pathogenesis, morphological and clinical-radiological manifestations, in which the diameter of each pathological formation is no more than 12 mm, i.e. does not exceed the transverse size of the pulmonary lobule.

The clinical and morphological feature of focal pulmonary tuberculosis is the limited nature of the tuberculous lesion, which is localized in separate isolated pulmonary lobes of one or two segments.

Along with its limited extent, focal tuberculosis is distinguished by the rarity of destruction in the affected area and a mild clinical picture. This form is often considered a minor form of pulmonary tuberculosis.

Focal pulmonary tuberculosis usually develops several years after the completion of the primary period of tuberculosis infection, therefore it is detected more often in adults and is diagnosed in approximately 6-15% of newly diagnosed tuberculosis patients. Among the contingents of anti-tuberculosis dispensaries, patients with focal tuberculosis make up about 25%.

There are fresh and chronic focal pulmonary tuberculosis. The advisability of such a division is due to important differences that should be taken into account when determining treatment tactics and duration of observation.

Pathogenesis and pathological anatomy. Fresh focal tuberculosis -the earliest, initial form of secondary tuberculosis in a person who was infected with MTB in the past and suffered the primary period of infection.

Fresh focal tuberculosis can arise as a result of repeated exogenous entry into the body of virulent MBT (exogenous superinfection). Another way of its development is the reactivation of endogenous tuberculosis infection in old residual post-tuberculosis changes - calcified primary foci and/or calcifications.

The role of exogenous superinfection is confirmed by the more frequent illness of persons who are in contact with

bacteria-shedding patients. The incidence of adult family members of tuberculosis patients is 8-10 times higher than among the rest of the population. Among medical workers at TB dispensaries, tuberculosis is also detected 5-6 times more often. There is another important evidence of the role of exogenous superinfection in the development of secondary tuberculosis - the primary resistance of mycobacteria to drugs in newly diagnosed and previously untreated patients. In this case, the MBT is found to be resistant to the same anti-tuberculosis drugs as in the patient who was the source of the tuberculosis infection. The importance of exogenous infection for the development of secondary tuberculosis is especially great in a tense epidemic situation and the absence of adequate measures for social, sanitary and specific prevention of tuberculosis.

The important role of endogenous tuberculosis infection in the development of secondary tuberculosis is confirmed by the more frequent detection of fresh lesions in individuals with residual post-tuberculosis changes in the lungs and/or intrathoracic lymph nodes. Old encapsulated tuberculous lesions and/or calcifications are found in approximately 80% of patients with fresh focal tuberculosis. Often old, with signs of exacerbation, tuberculosis foci are located directly in the area of ​​fresh foci. In these cases, the significance of old foci as a source of tuberculosis pathogens seems obvious. Reactivation of endogenous tuberculosis infection plays a major role in the pathogenesis of focal pulmonary tuberculosis in a favorable epidemic situation.

A necessary condition for the development of secondary focal tuberculosis is the weakening of the anti-tuberculosis immunity formed during the primary period of tuberculosis infection.

The weakening of anti-tuberculosis immunity is facilitated by overwork and malnutrition, mental and physical trauma, as well as acute and chronic diseases that disrupt cellular metabolism. The likelihood of developing secondary tuberculosis increases with hormonal changes in the body, as well as during treatment with immunosuppressants. Exogenous super infection also predisposes to reactivation of old foci of tuberculous inflammation.

Unfavorable factors of the external and internal environment reduce the bactericidal activity of alveolar macrophages, which favors the reversion of persistent mycobacteria into active, multiplying forms. The relative increase in the bacterial population is also facilitated by

Rice. 10.1. Tuberculosis pan bronchitis. Histological specimen.

repeated exogenous supply of MBT. Despite these important circumstances for the development of secondary tuberculosis, in the absence of significant changes in the general reactivity of the body and the preservation of the normergic reaction to MBT and their metabolic products, the protective phagocytic reaction is partially preserved. Macrophages absorb mycobacteria and fix them in the lung tissue. Emerging specificity

The inflammatory reaction is local in nature and limited to the pulmonary lobule.

According to the pathoanatomical studies of A. I. Abrikosov (1904), the first morphological changes in secondary tuberculosis appear in the small subsegmental branches of the apical bronchus of the upper lobe of the lung. The terminal branches of the posterior segmental bronchus may be involved in the pathological process. Sometimes the subsegmental parts of the apical bronchus of the lower lobe are affected.

The predominant upper lobe localization of secondary tuberculosis foci is due to the fact that the upper lobe of the lung has better conditions for their development. Limited mobility, insufficient ventilation, poor vascularization and slow lymph flow in the apex of the lung contribute to the settling of mycobacteria and the subsequent development of specific inflammation. Tuberculosis foci of secondary origin are more often found in segments I and II or IV of the lung. The lesion is usually unilateral, but bilateral localization of the process is also possible.

Exogenous or endogenous penetration of MBT into a previously undamaged pulmonary lobule through the bronchi or lymphatic vessels is accompanied by tuberculous lymphangitis around the intralobular bronchus. The inflammatory process also spreads to the bronchial wall. Intralobular caseous panbronchitis is formed, and aspiration of caseous-necrotic masses into the distal bronchioles and alveoli occurs (Fig. 10.1). This is how intralobular caseous bronchopneumonia develops (Abrikosov hearth). Aspiration of mycobacteria into adjacent intralobular bronchi, as well as their spread through the lymphatic vessels, leads to the formation of several foci of caseous acinous, acinous nodous or lobular pneumonia. The combination of such foci creates a pathomorphological picture of fresh

Rice. 10.2. Aschoff-Pull outbreaks. Histotopographic section.

focal tuberculosis. Initially, bronchopneumonic foci are predominantly exudative. Further weakening of the immune system can lead to the formation of a pronounced inflammatory reaction around the lesions and the development of infiltrative tuberculosis. In the absence of significant disturbances in the immune system and normergic tissue response to the MBT inflammatory

The reaction in the formed foci quickly becomes predominantly productive and the threat of rapid progression of the tuberculosis process decreases.

Timely diagnosis and adequate treatment contribute to the resorption of fresh tuberculosis lesions. In some cases they resolve completely. However, more often the resorption process is combined with partial replacement of specific granulations by connective tissue. Over time, a scar forms at the site of the outbreak.

The inflammatory reaction in focal tuberculosis can become chronic. In this case, signs of active inflammation in the lesion are combined with repair phenomena. Gradually, a fibrous or hyaline capsule forms around individual foci - these are Aschoff-Puhl foci (Fig. 10.2). The slow involution of tuberculosis foci and the chronic course of the disease lead to the transformation of fresh focal tuberculosis into chronic focal pulmonary tuberculosis.

The pathogenesis of chronic focal tuberculosis is associated not only with the slow involution of fresh focal tuberculosis. Resorption of inflammatory changes in disseminated, infiltrative, cavernous or other forms of pulmonary tuberculosis is usually combined with the development of perivascular and peribronchial fibrosis. At the same time, in place of areas of destruction, infiltrative foci and fresh foci of dissemination, encysted, dense, partially fibrotic foci gradually form.

Various forms of pulmonary tuberculosis in the process of reverse development can transform into chronic focal tuberculosis.

Chronic focal tuberculosis often has a favorable course. Signs of active tuberculous inflammation in the foci gradually disappear, and granulation tissue is almost

completely replaced by fibrous. Such inactive dense fibrous foci are considered as residual changes after cured tuberculosis.

During exacerbation of chronic focal tuberculosis, caseous masses in the lesions may undergo melting. If they are released into the bronchus, a decay cavity is formed. MBT with caseous masses penetrate into other bronchi, caseous bronchitis develops and new fresh lesions are formed. Along with the bronchi, nearby lymphatic vessels are involved in the inflammatory process. Lymphogenic spread of MBT leads to the appearance of new fresh foci in the lung. The increase in inflammatory changes in the tissue around the aggravated focus can lead to the formation of a pneumonic focus and the development of a more severe infiltrative form of pulmonary tuberculosis.

The pathogenesis of focal pulmonary tuberculosis is presented in Scheme 10.1.

Clinical picture. Fresh focal tuberculosis occurs inapperceptively in approximately one third of patients, i.e., below the threshold of consciousness of the patient.

In some patients, fresh focal tuberculosis is manifested by rapid fatigue and decreased performance, decreased appetite, and a slight decrease in body weight. Irritability and slight sweating are possible. Body temperature in the afternoon can sometimes rise to low-grade fever. These changes are caused by tuberculosis intoxication.

Symptoms of respiratory damage are rare. In some cases, when the pleura is involved in the pathological process, slight and intermittent pain occurs in the chest during breathing movements. An objective examination reveals a slight restriction of the respiratory movements of the chest on the affected side, and sometimes weakening of breathing over the affected area. Percussion rarely reveals any pathological signs. They appear only with the progression of tuberculous inflammation with the fusion of foci and a significant reaction from the pleura. In these cases, a shortening of the pulmonary sound is detected over the affected area and intermittent single moist fine bubbling rales are heard after coughing.

The progression of fresh focal tuberculosis is usually clinically manifested by increased symptoms of intoxication and the occurrence of cough with a small amount of sputum.

In patients with chronic focal tuberculosis, the clinical picture depends on the phase of the tuberculosis process and the duration of the disease. Symptoms appear during exacerbation

Scheme 10.1. Pathogenesis of focal tuberculosis

intoxication, cough with sputum, in some cases minor hemoptysis. Physical findings are largely due to fibrous changes in the lung tissue and deformation of the segmental and subsegmental bronchi. During examination, retraction of the clavicular space, narrowing of the Kroenig field, and shortening of the

pulmonary sound, hard breathing and local dry rales over the affected area.

Diagnostics. The diagnosis of focal tuberculosis often causes difficulties due to the absence of pronounced clinical and laboratory signs of the disease.

Tuberculin diagnostics(Mantoux test with 2 TE) in patients with focal tuberculosis does not allow one to suspect an active tuberculosis process. The response to intradermal administration of 2 TE in focal tuberculosis is often moderate, i.e. normergic. It is practically no different from the reaction of healthy people infected with MBT. If the reaction to tuberculin is negative, the cause of the anergy must be clarified. Some concomitant diseases (childhood infections, neoplasms, sarcoidosis, thyroid diseases), as well as external influences that suppress immunity, can weaken the severity of the specific response. However, in the absence of such factors and the satisfactory general condition of the patient who reacts negatively to tuberculin, positive anergy is very likely. In this case, the tuberculous etiology of focal changes in the lungs seems doubtful.

Subcutaneous injection of tuberculin (Koch test) has a certain diagnostic value. In patients with active focal tuberculosis, it can cause general and focal reactions, which are recorded when characteristic changes appear in clinical, laboratory and radiological data 48-72 hours after tuberculin administration. Positive general and focal reactions indicate active tuberculosis. However, the interpretation of the response to subcutaneous injection of tuberculin sometimes causes difficulties due to the individual characteristics of the body’s reactivity.

Information content bacteriological research with focal tuberculosis is not high. Decay cavities are rarely formed and have very small sizes. In this regard, bacterial excretion is infrequent and usually scanty. However, if focal tuberculosis is suspected, bacteriological examination is a mandatory component of the initial examination of the patient. Identification of MBT in diagnostic material allows one to verify the diagnosis and confirm the activity of specific inflammation. In the process of cultural testing, it is possible to determine the resistance of the tuberculosis pathogen to drugs and make the necessary adjustments to the treatment regimen.

If the patient has a cough with sputum production, it is subjected to bacterioscopic and cultural examination. The absence of sputum necessitates the importance of provoking inhalations with hypertensive dis-

solution of sodium chloride. Their irritating effect on the mucous membrane of the respiratory tract contributes to the release of a small amount of sputum, which the patient coughs up. Sometimes bronchial washings or washings from the walls of the bronchi obtained during bronchoscopy are examined.

increases the information content of bacteriological diagnostics.

X-ray examination - the most important component of examination for focal tuberculosis.

The main radiological syndrome of focal tuberculosis is a focal shadow, i.e. darkening with a diameter of no more than 12 mm.

The earliest radiological manifestations of fresh focal pulmonary tuberculosis can be detected by CT. They are represented by local delicate meshwork caused by intralobular bronchitis or lymphangitis (Fig. 10.3). These changes correspond to the initial stage of formation of the Abrikosov lesion. A later stage with the development of acinar-nodous and lobular intralobular caseous pneumonia can be detected with standard x-ray or fluorography. An x-ray usually shows a small group of focal shadows of low intensity, round in shape, with unclear contours. The sizes of the shadows are predominantly medium and large - from 4 to 12 mm. There is a noticeable tendency towards their merging. Lesions that have this appearance on an x-ray are often called soft (Fig. 10.4). With CT, you can clarify the nature of the lesion - determine the compaction of peribronchial and perivascular tissue around the lesions, visualize the lumen of the bronchus affected by tuberculous inflammation (Fig. 10.5). Sometimes a decay cavity is found in the lesion (Fig. 10.6). This X-ray picture is typical for fresh lesions with a predominance of exudative tissue reaction. The development of a productive tissue reaction contributes to a change in the characteristics of focal shadows on a radiograph. They acquire medium intensity, clearer contours, and their sizes

Rice. 10.4. Fresh focal pulmonary tuberculosis. Radiographs in direct projection. The shadows of the hearths are outlined.

decrease to 3-6 mm (Fig. 10.7). Focal shadows are well demarcated from the surrounding tissue and do not tend to merge (Fig. 10.8, 10.9).

As a result of specific chemotherapy, exudative lesions can completely resolve. Productive foci often gradually decrease and become denser. The interstitial tissue around the affected bronchi and lymphatic vessels also becomes denser, which leads to the development of limited pulmonary fibrosis. This is how the X-ray picture of chronic focal tuberculosis is formed, in which, against the background of a deformed pulmonary pattern,

Rice. 10.5. Fresh focal pulmonary tuberculosis.

a - peribronchial and perivascular compactions; b - lumen of the bronchus among the foci. CT.

focal shadows of small and medium size, high or medium intensity (Fig. 10.10).

CT makes it possible to clearly visualize, along with dense, well-demarcated foci, tissue compaction around the foci, to identify deformed small bronchi and vessels, fibrous strands directed towards the pleura, and areas of emphysema (Fig. 10.11). Such changes are often called fibrofocal.

During exacerbation of chronic focal tuberculosis, con-

Rice. 10.6. Fresh focal pulmonary tuberculosis. Decay cavity in the hearth. CT.

the contours of some focal shadows become blurred, and new focal shadows of low intensity appear in the surrounding lung tissue. Areas of destruction can be found in the lesions, and around the lesions there are signs of bronchitis and lymphangitis (Fig. 10.12, 10.13). The significant duration of the process and the absence of a tendency to progression are manifested by a predominance

signs of fibrous compaction of the lung tissue and pleura. The lesions shift to the area of ​​the apex of the lung and gradually transform into fibrous formations.

Tuberculous lesions of the bronchial tree in patients with fresh focal tuberculosis

lung disease fiberoptic bronchoscopy rarely diagnosed. It can occur when endogenous tuberculosis infection is reactivated in the intrathoracic lymph nodes. In these cases, a nodulobronchial fistula is sometimes detected. However, more often a scar is visible on the bronchial mucosa as a trace of bronchial tuberculosis suffered in the primary period. In chronic focal tuberculosis, bronchoscopic examination can reveal bronchial deformation and diffuse nonspecific endobronchitis.

In general blood test in most patients with focal tuberculosis there are no changes. In some patients, a slight increase in the content of band neutrophils, lymphopenia or lymphocytosis, and an increase in ESR (no more than 10-18 mm/h) are detected.

During immunological research You can detect minor changes in indicators of humoral and cellular immunity, more often in patients with fresh focal tuberculosis.

OVD in focal tuberculosis is usually not impaired. Minor respiratory impairment in some patients is caused by intoxication and not by damage to the lung parenchyma. Under the influence of intoxication, hicardia and lability of blood pressure can also be observed.

It is often not possible to verify the diagnosis of focal tuberculosis using studies traditionally used in medical practice. In these cases, it is advisable to use molecular biological diagnostic methods, in particular PCR.

To clarify the tuberculous etiology of lesions in the lungs

Rice. 10.7. Evolution of fresh focal pulmonary tuberculosis.

a- exudative foci; b - productive foci. Radiographs in direct projection with an interval of 2 months.

The response to specific chemotherapy is of unconditional importance: reduction and, especially, resorption of lesions confirms the diagnosis of focal tuberculosis. An indirect sign that allows us to assume the specific nature of the disease is the absence of positive dynamics of the process due to the use of broad-spectrum antibiotics that are not active against the causative agent of tuberculosis.

Rice. 10.8. Focal pulmonary tuberculosis. Productive hotspots. X-ray in direct projection.

Differential diagnosis. Focal pulmonary tuberculosis is usually detected by control fluoro- or radiography. When assessing the radiological picture, the asymptomatic clinical course, the upper lobe (apical) localization of the lesion, the presence of fresh and dense (old) lesions, and fibrosis in the lung tissue are taken into account. These signs are typical, but not pathognomonic for focal tuberculosis. It must be differentiated from peripheral cancer or a benign tumor, nonspecific focal pneumonia, or fungal infection of the lung.

Rice. 10.9. Focal pulmonary tuberculosis. Productive hotspots. CT.

Rice. 10.10. Chronic focal pulmonary tuberculosis. Fibrous lesions. Radiographs in direct projection.

The X-ray picture of focal tuberculosis may be similar to a lung tumor - peripheral cancer or, less commonly, a benign neoplasm. Cancer of the small bronchus and bronchoalveolar cancer in the early stages manifest themselves as focal shadows in any part of the lung, including at the apex. The differential diagnosis takes into account epidemiological aspects and the more frequent occurrence of cancer in old age in men who smoke. They analyze the details of the CT image and try to detect MBT or tumor cells by bacteriological and cytological examination of the bronchial contents. If these attempts fail, a test is sometimes used in clinical practice

Rice. 10.11. Variants of fibrous-focal changes in the lungs. CT.

Koch, PCR. In complex and doubtful cases, a trial prescription of anti-tuberculosis drugs for 2-2.5 months followed by CT monitoring is common. Positive dynamics indicate tuberculosis, and absence of changes or an increase in size indicates a tumor. It is important to explain such tactics to the patient and not to exceed the time limits for trial treatment and control.

Nonspecific focal pneumonia differs in a more acute onset and severity of clinical manifestations of the disease. Increased body temperature, cough with phlegm, and moist rales in the lungs in patients with focal pneumonia are much more common than in patients with focal tuberculosis. Pneumonic foci are localized predominantly in the lower lobes of the lungs, and on radiographs, unlike tuberculosis foci, they appear as shadows of low intensity.

Rice. 10.12. Exacerbation of chronic focal pulmonary tuberculosis, a - radiograph; b - longitudinal tomogram in direct projection.

intensity. After 2-3 weeks of treatment with broad-spectrum antibacterial drugs, focal shadows caused by pneumonic foci disappear.

Differential diagnosis of focal tuberculosis, focal pneumonia, peripheral cancer and benign tumor is presented in Table. 10.1.

Differential diagnosis of focal tuberculosis and fungal diseases is based on the examination of sputum or bronchial contents for fungi, as well as the results of examination of biopsy specimens from the area of ​​lung compaction during transthoracic needle biopsy.

Rice. 10.13. Exacerbation of chronic focal pulmonary tuberculosis. CT.

Table 10.1. Differential diagnosis of focal tuberculosis

for, focal pneumonia, peripheral cancer, benign tumor

		Focal tu	Focal	Peripheral	Good quality
					vennaya opu
		berculosis	pneumonia
	Age, gender	Adults,	Independent	More often the husband	Regardless
		more often the husband	mo from voz	ranks of old	from age and
			rasta and po	over 40 years old -
			yeah, more often	smokers
			then gasp
			getting along
	Periphery	Don't increase it	Don't cheat	Increase
	logical lim			with meta-
	phatic			stasis-
	The beginning and those	More often than not	Spicy, according to	More often hide	More often length
	care		sedate,	that, post	secretly
		no post	progress		that is, perhaps
				progress	but slow
					new progress
					siping
	Roentgenolo	Ocha group	Ocha group	Focal	Focal
	gical	gov those	gov those	shadow, usually in	shadow, usually in
	signs	her (sometimes	her little one
		polymorph	intensively	segments;	segments on
		nykh), more often	sti, more often in	increase	unchanged
				regional
		segments;	segments,	lymph
		available	gain	tic bonds
		local	pulmonary	fishing with me-
		pneumofib-		tastazirov-
				research; cart
			resorption	maybe lo
			adequate	gain
				pulmonary
	Bronchosco		Spilled ghee	Often burrows
		sometimes rub-		ma; Sometimes
		tsovnye ism	mucous membrane	with metastasis
			shells,	zing in
			mucous-	lymphatic
				sky knots
				bulging
			lumen
	Bacteriolo		Non-specific
	gical art		chesk mick
	following
Morphologists		Increased	Tumor
logical information
following		neutrophy-
bronchial		fishing, plasma
nogo content		cyts, eosi-
Sensitive	Hyperergic	Loose-hem	Loose-hem	Loose-hem
affinity for that	chesical or	resident	resident	resident
berculina	normergic	or deny	or deny	or deny

In patients with focal tuberculosis and poor health, thyrotoxicosis or vegetative-vascular dystonia. In these conditions, unlike tuberculosis, low-grade fever is monotonous and resistant to the action of antipyretic and antituberculosis drugs, which are sometimes prescribed for diagnostic purposes. X-ray examination of the lungs and bacteriological examination of bronchial contents play a decisive role in differential diagnosis.

is a form of secondary tuberculosis that occurs with the development of small foci of specific inflammation. Their size does not exceed 10 mm in diameter.

It is practically asymptomatic or asymptomatic.

Most people experience minor malaise, low-grade fever, discomfort, and a dry cough.
To make a diagnosis, an X-ray of the lungs is performed and MBT is detected in sputum or bronchial washings.

Therapist: Azalia Solntseva ✓ Article checked by doctor

Focal pulmonary tuberculosis among the population

In most cases, the disease is secondary and occurs against the background of an active or latent primary condition.

Clinically manifests itself as a disease of mild or moderate severity. It often occurs asymptomatically, without objective and subjective signs.

The described form of pathology can only be detected with an X-ray or tomographic examination of the chest. Approximately half of the adult population has encapsulated lesions of the lungs or bronchial lymph nodes, while in one third of patients the lesions are firmly calcified and heal completely.

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Contagious or not to others

If the disease has developed in the lungs and it is active or untreated, it should always be assumed that mycobacteria can be transmitted to another person. The pathology can spread to others through droplets in the air produced by sneezing, coughing and contact with sputum. Therefore, you can become infected with the disease through close contact with infected people.

Outbreaks of the disease occur in closed and crowded rooms and areas.

Is focal pulmonary tuberculosis contagious or not to others? The incubation period, depending on the location, activity and size of the lesion in the lungs, can vary from two to 12 weeks. A person can remain contagious for a long time and until they have been treated for several weeks.

It should be borne in mind that some people are carriers of the infection for a very long time, but this is not visually determined. Usually this corresponds to an inactive form of the disease and microorganisms are in hibernation mode during this period. In this case, the person is not contagious to others and can lead a normal life. When such persons are identified, they are prescribed special treatment.

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Left lung disease - features, symptoms

Literature, opera, and art have popularized the traditional symptoms and signs of pulmonary tuberculosis: cough, sputum, hemoptysis, shortness of breath, weight loss, anorexia, fever, malaise, weakness, and terminal cachexia in various combinations, not only in the descriptions of heroes, heroines, and villains, but also among artists, poets and musicians. However, none of these symptoms are characteristic of focal tuberculosis.

Currently, patients who have the full spectrum of symptoms are rare in developed countries, but doctors and health care providers often see such patients in developing countries.

Usually, with this form, nonspecific signs of intoxication and inflammation of the mediastinal lymph nodes appear. With a significant increase in these formations, symptoms of compression are noted, which manifest themselves in the form of shortness of breath and pain, both at the peak of inspiration and during local palpation. The latter is most often observed when pressure is applied in the space between the collarbone and scapula, in the area where the apex of the left lung is located.

There may be a slight increase in normal body temperature, up to 37 degrees.

Increased night sweats, which cause subjective discomfort to the patient, are not always observed and depend on the individual reaction of the body.

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Effective treatment of pathology

Standard therapy recommended by the International Union Against Tuberculosis and Lung Disease, the World Health Organization and the National Institute for Health and Clinical Excellence (NICE) consists of six months of rifampicin and isoniazid (usually given as a combination tablet), initially supplemented with 8 weeks of pyrazinamide and ethambutol.

It is important not to violate the treatment regimen, only this guarantees a positive result. A reliable drug is available that contains rifampicin, isoniazid and pyrazinamide in one medication. A tablet containing all four drugs is also available. They have the great advantage of reducing the possibility of drug resistance emerging.

Pyridoxine is indicated only in malnourished patients or in patients at risk for peripheral neuropathy. Results of susceptibility tests are usually available until the end of the two-month intensive treatment period: provided that the organisms are susceptible to rifampicin and isoniazid. If possible, therapy should be confirmed by smear and sputum culture at the final stage.

1. In developing countries, if patients have a cough that persists for more than three weeks despite broad-spectrum antibiotics, sputum should be checked for the presence of acid-fast bacilli.
2. The appearance on chest radiographs is often less specific in immunocompromised patients. Images may not reveal lesions.
3. In the absence of evidence of previous infection or BCG vaccination, strong positive Mantoux test results increase the likelihood that a person has tuberculosis, even if the sputum is negative.
4. If drug resistance is detected, the treatment regimen must be modified and expanded.
5. Cross-infection is more likely if the patient has sputum positive for acid-fast bacilli.
6. Home therapy is no more likely to result in cross-infection than hospital treatment.
7. BCG vaccination should be offered to all people at high risk of contracting tuberculosis.

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What does an x-ray show?

The site of infection can be located anywhere in the lung and has nonspecific findings, ranging from too small to detectable with nodular areas of consolidation. In most cases, the disease becomes localized and forms a granuloma (tuberculoma), which eventually calcifies and becomes visible on x-ray as a nodule.

A common symptom is concomitant mediastinal (paratracheal) lymphadenopathy. This pattern is observed in more than 90% of cases of focal tuberculosis in children, but only in 10-30% in adults. These nodes typically have low-density centers with increased edge contrast. Sometimes they can be large enough to compress adjacent airways, resulting in distal atelectasis.

Pleural effusions are observed more often in adults, visible on photographs in 30-40% of cases.

Since the patient develops an immune response, both pulmonary and nodular inflammation is stopped. Calcification of nodes is observed in 35% of cases.

Post-primary or secondary pulmonary tuberculosis occurs years later, often in conditions of decreased immune status. In most cases, it develops in the posterior segments of the upper lobes and the upper parts of the lower petals. The typical manifestation is heterogeneity of tissue structure and poorly defined linear and nodular opacity.

True focal tuberculosis accounts for only 5% of cases of primary disease and is detected as a well-defined round mass, usually located in the upper lobes. The nodes can usually be single (80%) up to 4 cm and multiple, but small. In most cases, minor lesions of the lymphatic system are observed.

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How does disease of the upper lobes of the right and left lungs manifest?

When the source of infection is located in the specified tissue area, usually no specific symptoms develop. The severity and severity of general manifestations depend on the size of the lesion in the right or left organ, which can be up to 4 cm in diameter (usually up to 10 mm), as well as on the body’s ability to suppress foreign microorganisms.

Nonspecific signs include: weakness, malaise, lack of appetite, headaches, low and intermittent fever.

Under other conditions, signs appear that allow you to indicate damage to the lungs and their apices:

1. Pain in the supraclavicular areas, as well as in the forearm area, which intensifies at the peak of inspiration or during physical exertion. It may be intermittently cramping in nature.
2. Lymphadenopathy. Usually, an increase in the cervical and axillary lymph nodes is observed, since they are closest to the source of infection and react to its presence earlier than others.
3. Fever.
4. Uneven breathing due to tuberculosis infection.
5. Night sweats.
6. Pneumonitis (may be the only symptom in older people).

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Complications and development of primary foci of tuberculosis infection

Often, symptoms of pleurisy are the first thing that attracts the attention of a patient or doctor to a lung disease. The most common form is the dry adhesive form of the disease. The appearance of primary foci is observed.

The tubercles that affect the pleura and the exudate that connects them together form a conglomerate and thus stable adhesions are formed. It can develop in any part of the chest, but most often in the upper third of the lung. The discomfort is often painful, but can sometimes be severe. People often complain about their shoulders and discomfort in their area.

However, we should not forget that pleurisy can include the diaphragm and lead to true pathologies not only of the upper limbs, but also of the abdomen.

The acute type of pleurisy presents a completely different picture. Very high fever is often observed, sometimes above 40°C. There are other symptoms of intoxication, asthenia and very rapid exhaustion are noted. Signs of effusion soon appear, with the patient experiencing relief from severe pain.

This occurs due to decreased friction between the inflamed pleural layers. The effusion may fill only part of the cavity or all of it.

Often pleurisy, as described above, is the first sign in patients with focal pulmonary tuberculosis, and if no other cause is found, and tuberculous bacteria are not detected in the fluid and no parenchymal involvement is observed, it is best to treat these patients as for tuberculous involvement.

Purulent effusions are most often observed with pneumothorax. This is especially likely after spontaneous occurrence, when the pleural space is contaminated with air and secretions from the bronchi.

The second and most difficult process is the generalization of infection. In this case, the bacilli from the focus move to other parts of the lungs, and with weak immune defense they spread throughout the body. This can lead to tuberculosis of any organ, but most often microorganisms linger in the bone and nervous systems, causing symptoms of complications.

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Small focal pulmonary tuberculosis - causes, symptoms, treatment

The pathology occurs identically in adults and children. It can begin between the ages of 2 and 10 years, but more than half of all cases manifest between 10 and 18 years of age.

Infection can develop:

• primarily after inhalation of aerosol droplets sprayed into the air after a sick person coughs or sneezes.
• secondary, as a result of activation of dormant mycobacteria.

Symptoms depend on the individual characteristics of the body and the extent of the process:

• pale skin;
• abdominal pain;
• cough and shortness of breath;
• fever;
• general discomfort, restlessness or malaise;
• chills;
• weight loss;
• sweating;
• enlarged tonsils and regional lymph nodes;
• fatigue.

The goal of therapy is to eliminate the infection with drugs that fight tuberculosis bacteria. Treatment involves a combination of several medications (usually four). Treatment continues until laboratory tests show the absence of mycobacteria in the body. You may need to take different tablets for 6 months or longer to cure small-focal TB.

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Fresh subspecies - secondary form

It is a secondary pathological process. Occurs after a previous disease, which was activated after inadequate treatment or as a result of inactivity of mycobacteria. There is no difference in the clinical picture between a fresh and fibrotic focal process.

What is the difference between fresh focal tuberculosis and focal pulmonary tuberculosis? The main difference lies in the X-ray picture, where fresh tuberculosis is characterized by blurring of the focus of infection: its unclear edges and the absence of a necrotic center. X-rays will help identify the form of the disease.

The secondary form has the following symptoms:

• slight weakness, fatigue;
• fever
• increased night sweats;
• anorexia;
• weight loss;
• digestive disorders;
• amenorrhea.