Focal and infiltrative tuberculosis

Deepak Leichombam

Focal tuberculosis
focal TB - is a form of the disease which is characterized by limited extent of inflammation in the lungs with a predominance of productive nature of inflammation in the body. The length is usually determined by 1.2 segment. If you take the radiological evidence, it usually takes spatial field is not less than 2 edges, ie when the focal changes in lungs are in the upper segments. If you change the focal spread below the second rib - that such a process is called disseminated tuberculosis.

Focal tuberculosis
focus - it concept pathomorphological. Isolated in the inflammatory process during tuberculosis two options: home and infiltration. focus - it a focus of inflammation, which is no larger than 10 mm. Pathologists share their small (within 3-5 mm), medium (5-8 mm), large (10 mm). When focal tuberculosis, these centers could not be more than 10 mm, because this during inflammation - productive.

Focal tuberculosis
Here are TB tubercles, which are a large number of epithelioid cells, distinguished cheesy, small foci containing mycobacterium tuberculosis. Given that these changes are in the limited space, these tricks limited in scope, respectively, and clinical symptoms in focal tuberculosis is very, very poor. The patient usually complains only on the syndrome of intoxication, which is usually accompanied by the appearance of only subfebrile the evening.

Signs and symptoms

Less frequently the patient complains of symptoms vegetososudistoy dystonia, which are a consequence of the same syndrome of intoxication. Complaints night sweats, headaches, fatigue, etc. But usually the background of good being, good performance, in the evening in such a patient appears low-grade fever.

diagnosis
This form, with such meager symptoms may reach the patient's age and if he does not go to the doctor, then respectively diagnosis is not revealed. At certain times the patient feels very well - he disappears low-grade fever, no complaints, and in the spring or fall suddenly begins to appear deteriorating state of health, time passes and Again condition is improving. And only when x-rays or X-ray at patient identify focal pulmonary tuberculosis.

diagnosis
In 50-60 years we have focal Tuberculosis was a lot - within 40-50% of the identified focal tuberculosis. With years, in connection with the use of mass fluorography, early detection tuberculosis, a change in the immune background proportion of focal tuberculosis falls, despite the high incidence of tuberculosis in our country (5%, in some areas up to 8%).

Pathogenesis focal tuberculosis

To date unambiguous hypothesis regarding No focal tuberculosis. Some believe that this is a consequence of exogenous infection (or exogenous superinfection in previously infected person, while getting a fresh portion of mycobacterium tuberculosis which falls as usually in the upper part, develops the limited nature of foci of inflammation, because people in this case, the previously infected or in childhood recover from some form of primary tuberculosis infected slabovirulentnym strain on the background of good reactivity of the organism.

pathogenesis
Some experts believe that is a consequence of retrograde flow of lymph, the persons who have suffered in childhood tuberculosis lymph nodes, which left the residual changes after transferred in the form of tuberculosis petrifikatov, and at some stage, when reactivity decreases (stress, respiratory diseases -- influenza and herpes), which leads to the exit of Mycobacterium tuberculosis petrifikatov and with current lymph recorded in the upper segments of the lungs. In the first hypothesis of a focal TB - the result of exogenous infection, the second - an endogenous infection.

pathogenesis
Nature current foci of tuberculosis, in principle, favorable. But especially in his that he is inclined to the wavy current. This form of TB may evolve over the years, and the patient does not come to a doctor. These patients usually without bacterial isolation, that is not dangerous to others, because, in the hearth No destructive changes, as a rule. The centers are heavy enough, mycobacterium tuberculosis are not able at this exit.

treatments
In general, among patients bakteriovydeliteley - a maximum of 3%. Even with the decay foci, also minimum of bacteria - within a maximum of 7-10%. Progression focal tuberculosis - a rarity. This form of TB is usually lends itself to be usually chemotherapy - three anti-TB drugs, with sufficient discipline and healthy lifestyles, the patient is treated quickly.

examination
Reliably diagnose focal tuberculosis is placed only after the X-ray. peripheral blood: normally not changed. Red blood - almost always normal, leukocytes the same in the normal range. Sometimes you can see some lymphopenia, and a slight increase in the number of monocytes.

examination
in normal sputum for microscopic examination, as a rule, no detected. In these patients, detect mycobacteria, using additional methods of research - the washings bronchi during bronchoscopy try to take wipes, if you see a picture endobronchitis - in this case sometimes find scant bacteria.

classification
Sometimes the TB doctors in the form of focal TB allocate 2 options: myagkoochagovaya form fibroznoochagovaya form (may be the result transferred infiltrative tuberculosis) This is in general a pathologoanatomic diagnoses. Diagnosis: focal tuberculosis S1-S2 of the right lung in the phase of infiltration, decay scarring, calcification, etc.

Infiltrative tuberculosis.
If focal Tuberculosis is characterized by limited distribution in the lung, scarce symptoms and quite favorable trend, but prone to chronic, then infiltrative tuberculosis is not confined to any one section of lung fabric - it may be small infiltrates, infiltrates, exciting a segment tselyu share, the whole lung and both lungs. Naturally, the volume of lung lesions matter manifestation of clinical symptoms.

Infiltrative TB
infiltration -- a focus of inflammation, in which the predominant exudative phase of inflammation. A once dominated exudation, the rapidly increasing infiltration - that is around this Focal inflammation is the arrival of lymphocytes and leukocytes. TB doctors distinguish Several forms of such infiltrations - they may be: Rounded and cloud

types
rounded (as Generally, subclavian infiltrates). In 20ies described Asmann. In subclavian area reveal rounded infiltration, but unlike the foci of tuberculosis, he always greater than 10 mm (usually within 15-25 mm). Infiltration has rounded shape, with no clear boundaries - suggesting fresh inflammatory process. cloud--- inhomogeneous, exciting 1 or 2 segments. They can occupy the entire portion of light - Lobito located in one or two segments of the lungs, but in the course of inter-tissue gap (ie limited boundary of the pleura) - perifissurity.

Clinical pictures
Unlike focal tuberculosis is clearly apparent dependence of the clinical picture the amount of infiltration. Since there is infiltration, then the clinic is usually characterized by pneumonia. In contrast to the nonspecific pneumonia, all symptoms of a relationship between the size of infiltrate. This form of tuberculosis is often called infiltrative-pneumonic, and until 1973 , this form was in the classification.

Signs and symptoms

Often, clinical symptoms begin acute patient for 1-2 days the temperature rises to 39 degrees. Ill is in bed, lying in the restricted activity, the state sometimes difficult. This form of tuberculosis, in contrast to focal tuberculosis very quickly undergoes degradation - very quickly in these infiltrates formed decays lung tissue, a cavity formed by the collapse.

signs
In this form of TB state of the organism - hyperergic patient highly gipersensibilizirovan to infection, so prevalent in the exudative phase. Cells phagocytose mycobacteria and destroyed by allocating a large number proteolytic enzymes, which lyse cheesy mass. Cheesy masses diluted, and these pockets drained 1.3 bronchi, and the patient, these liquid mass expectorate, and this place is formed cavity. Such patients are massive bakteriovydelitelyami.

Cont..
It is dangerous to others sick. Especially if reveal infiltrative tuberculosis in the form of Lobito, where large masses of cheesy number, is lizirovanie these cheesy masses and patients zakashlivayut these masses in a different light (bronchiogenic distribution) very fast shatters both lungs. And in this case, if not taken adequate therapy, such a patient can be quickly lost.

treatement
Infiltrative TB has its approach to the treatment. The first step is to appoint desensitizing therapy prescribed 15-20 mg prednisolone. When cloud - infiltrate can be assigned to 30 mg prednisolone. Also designate 3.4 TB drugs. If appointed by the 4 drugs - the 2 of them parenteral isoniazid, streptomycin, and 2 inside. Or 1 inside, 2 parenterally, 1 in the form of inhalations. Parenteral introduction of highly profitable. When lobite infusion therapy up to 1 liter (since there dehydration), protein hydrolysates. It is better to put TB catheter.

outcome
Outcomes infiltrative tuberculosis: a cure (most often). Subclavian rounded infiltrates with Helicobacter pylori eradication dissolve without a trace. May remain fibronodular plot (rarely). cloud - (captured by 1.2 + segment destructive changes) after treatment remain extensive fibronodular field with the deformation of the lung tissue (put for dispensary registration group life and 7). Lobito (extensive cheesy changes) - formed giant cavity decay, as a rule, they hroniziruyutsya because this cavity is not closed. If such a patient in a timely manner is not intended to surgical treatment, it is chronic, first in cavernous form (even with treatment), then the fibrocavernous form (the most dangerous to others).