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Primary tuberculosis.

Primary intoxication is a clinical syndrome in children and adolescents caused by primary tuberculosis infection, manifested by functional disorders in the absence of other clinical and radiological manifestations of the disease against the background of a turn of tuberculin reactions.

The primary tuberculosis complex is characterized by the presence of a triad - pulmonary pneumonic focus, the so-called. affect, lymphangitis and regional lymphadenitis (Fig. 18-22).

Features of the course: uncomplicated outcome in healing, complicated (progressive), the transition to the chronic form (Fig. 2327).

Variants of progression: “local” - a progressive primary affect or lymph-iron component of the primary complex; generalization - lymphogenous, hematogenous, mixed (in the presence of tuberculous bronchoadenitis, the lung is “secondarily” involved in 5–70%).

Complications: transformation of primary affect into a cavity, a lesion such as tuberculoma, caseous pneumonia, a breakthrough into the pleura with the development of empyema. With progressive lymphadenitis associated bronchopulmonary complications bronchial fistulas, obstructive airways disease, aspirate material pathogenic developmental caseous pneumonia, hypo- and hyperventilation, atelectasis development fibroatelektaza, bronchiectasis, polycystic and tuberculous pleurisy and pericarditis (Figure 28-38.).

Development of tuberculous meningitis, as well as generalized miliary T, is associated with hematogenous progression.

Chronically current primary tuberculosis (Fig. 39-40) occurs during the healing of the primary affect and the progressing wave-like course of the tuberculous inflammation and lymphatic-iron component of the primary complex, as well as during the development of "primary pulmonary tuberculosis".

Paraspecific tissue reactions typical for chronic primary T occur on the basis of GNT or DTH, manifest diffusely-nodular proliferation of lymphocytes and macrophages, hyperplastic processes in hematopoietic tissue, fibrinoid changes in the connective tissue and arteriole walls, and dysproteinosis (Fig. 39—40). Paraspecific reactions are the anatomical equivalent of tuberculosis masks. A typical example of “masks” is joint damage (“Ponce's rheumatism”).

Reparative processes in the foci of the primary complex occur up to 4 years after infection and disease. Pulmonary affect is primarily affected, then pleural effusion and pulmonary foci of screening. The process lasts the longest in the intrathoracic lymph nodes. Morphologically, there is a resorption of perifocal inflammation, a change in the exudative tissue reaction to a productive inflammatory process with encapsulation of the center of specific inflammation during the formation of a shaft of fibrosing tuberculosis granulations. The caseous masses are compacted due to dehydration, calcified, ossified.

Healed primary affect is referred to as Gon's focus.
In place of tuberculous lymphangitis, fibrous cord is formed.

Congenital tuberculosis (Fig. 41-43) is defined as intrauterine infection with tuberculous deciduitis and placenta or miliary T of the mother, the development of a primary disease during aspiration of infected amniotic fluid or by breathing mouth to mouth by a person carrying obstetrics; primary abdominal T for oral infection during childbirth or immediately after it.

With the penetration of the Office through the placenta and umbilical vein, large foci of caseous form in the liver, spleen, combined with hematogenous generalization. When aspirating pathogenic material in the lungs of a newborn, multiple bronchoalveolar foci of rose develop with a nonspecific perifocal inflammatory reaction, necrotic foci appear in the regional lymph nodes (Fig. 41-43). In the gastrointestinal tract in the manifestations of tuberculous inflammation also dominated by necrotic changes.

Clinical specificity of T newborns has not.

BCG vaccination (BCG). In the prevention of T (protection against primary tuberculosis infection with the danger of generalization), vaccination and revaccination play an important role, the protective effect is 80%.

The BCG vaccine, received by Calmett and Guerin in 1919 as a result of multiple passages of M.Bovis, is a live vaccine. In Russia, vaccination is carried out to all newborns (in the absence of contraindications) with BCG-M vaccine. Children of preschool and school age revaccinated three times.

The vaccine is injected intracutaneously on the border of the upper and middle third of the shoulder. The vaccination reaction appears after 4-6 weeks with the appearance of an infiltrate of 5-10 mm in size, with a crust in the center or pustules. After 2-4 months, a post-vaccination scar forms.

Contraindications to vaccination: prematurity (with a body weight of less than 2000 g), intrauterine infection, purulent-septic diseases, hemolytic disease, birth injury with neurological symptoms, acute diseases.

Complications after vaccination (0.02%): development of ulcers, infiltrates, subcutaneous cold abscesses, regional lymphadenitis, keloid scars, osteomyelitis, generalization, often in the form of generalized lymphadenopathy.

The morphological manifestations of the vaccination process and its complications are basically identical to the manifestations of tuberculous inflammation: epithelio-macrophage granulomas with multinuclear giant cells and caseous foci with a granulation shaft. With uncomplicated vaccine process in the internal organs (lymph nodes, liver, spleen, lungs) of vaccinated children for several years after vaccination, it is possible to detect single epithelioid cell granulomas without necrosis.

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Primary tuberculosis.

  1. Primary tuberculosis.
    Primary tuberculosis is a disease that coincides with the period of primary infection. Peculiarities of primary tuberculosis - children's age (may occur in HIV-infected or severely weakened patients), severe sensitization and the presence of paraspecific reactions (vasculitis, arthritis, serositis); tendency to hematogenous and especially lymphogenous generalization, lymphotropic,
  2. Primary tuberculosis
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  3. Tuberculosis
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    Motivational characteristics of the topic. Knowledge of subject materials is necessary for the study of tuberculosis in clinical departments. In the practical work of the doctor, this knowledge is necessary for the clinical and anatomical analysis of this pathology. The overall goal of the lesson. According to the knowledge of the morphological manifestations of tuberculosis, learn to identify the clinical and anatomical variants of various forms of this serious infectious disease. Specific
  6. Tuberculosis
    1. Forms progression of primary tuberculosis complex a) bronchogenic b) in hematogenous) intrakanalikulyarnaya g) perineural d) tuberculoma correct answer: b 2. Clinico-morphological form hematogenous and tuberculosis) caseous pneumonia b) limfozhelezistoe progression c) generalized tuberculosis g) acute cavernous d) fibro-cavernous The correct answer: in 3. Cord factor
  7. Secondary tuberculosis.
    This is the most common form of tuberculosis encountered in practice. Secondary pulmonary tuberculosis occurs in adults, in whom at least a small primary tuberculosis affect, and often a complete primary complex, developed and safely healed. To date, there is no consensus about the source of infection. Apparently, secondary tuberculosis occurs either due to
  8. Hematogenous tuberculosis
    • Occurs after suffering primary tuberculosis in the presence of foci of hematogenous screening or not fully healed foci in the lymph nodes against the background of pronounced immunity to mycobacteria, but increased sensitivity (sensitization to tuberculin). • Productive tissue reaction (granuloma) prevails. • A tendency to hematogenous generalization. Varieties
  9. Lupus
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